Housing Waitlist Form

1

Name* This field is required.

First Name

Last Name

2

Email

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Are you able to live in shared housing? * This field is required.WE ONLY PROVIDE SHARED LIVING HOUSING. Shared housing = you live with others in the same home and share common areas (kitchen, living room, bathroom). You may have a shared bedroom or a private bedroom, depending on availability and budget.

Yes, I’m open to a shared bedroom (Rent starts at $650/mo)

Yes, I prefer a private bedroom (Rent starts at $950/mo)

No, shared housing won’t work for me

5

What is your monthly rent budget? * This field is required.All utilities are included.

$750–$900 / month (Shared bedroom options may be available)

$900–$1,200 / month (Private bedroom options may be available)

6

Who will be moving in?* This field is required.

Just me

Me + kids

Me + pet(s)

7

Preferred area/county?* This field is required.List your top 1–3 counties/cities. If you’re flexible, type “Next available.”

8

How did you hear about G.L.A.S. Angels?* This field is required.Name the person/organization, or type “Online.”

9

Do you need any support services? (Check all that apply)Select what you may need. If none, choose “None.”

10

Age?* This field is required.

11

What gender is on your birth certificate?* This field is required.

Man

Woman