Housing Seeker Pre-Application Requirements*
*
I am a current resident of Los Angeles County.
I receive an income of at least $1,200 every month.
I have never been convicted of a crime.
I have never been evicted.
I am able to perform all activities of daily living without assistance from others.
Full Name*
*
Email*
*
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Landlord (Name/Contact Info)
Landlord (Name/Contact Info)
How long have you resided in California?
Are you open to any potential homes in LA County? If not, please check the areas of Los Angeles where you would be open to a home.
West Los Angeles
East Los Angeles
Hollywood
South Los Angeles
South Bay
San Fernando Valley
Other
If other, please list
Are you interested in offering assistance with household duties in exchange for a reduced rent?*
*
Yes
No
If applicable, how many hours per week are you willing to assist?
1 to 5
5 to 10
10 to 15
If applicable, select the tasks you are willing to perform
Select All
Housekeeping
Shopping
Cooking
Laundry
Transportation
Companionship
Other
What is your current rent?
*
What is the maximum amount of rent you can afford to pay?*
*
What's your total monthly income?*
*
Source of income (check all that apply)
Social Security
Employment
Pension
Other
Have you ever shared housing with a non-family member/spouse?*
*
Yes
No
Are you employed?
Yes
No
If yes, please include name, address, telephone
Do you prefer a private bathroom?*
*
Yes
Don't Mind
Do you prefer a house without stairs?*
*
Yes
Don't Mind
Do you prefer a furnished room?*
*
Yes
Don't Mind
What other preferences should we be aware of?
Describe your typical daily schedule
On a scale of 1 to 10, how would you rate your housekeeping standards?
1
2
3
4
5
6
7
8
9
10
How often do you have company?
Never
Sometimes
Always
How often do you have overnight company?
Never
Sometimes
Always
Are you fluent in any language other than English?
Examples: Spanish, Mandarin, Armenian
Do you have pets? If yes, what kind?
Do you smoke?
Do you drink alcohol?
Do you have any medical conditions that affect your day-to-day life?
*
Do you have a special diet that a roommate would need to be aware of?
Examples: Kosher, vegetarian/vegan, salt-free
Rental Duration Preference*
*
Month-to-Month
3 Months
6 Months
1 Year
1 Year or longer
On a scale of 1 to 10, how clean do you prefer your roommate to be?
1
2
3
4
5
6
7
8
9
10
On a scale of 1 to 5, how often would you like to interact with your roommate?
1
2
3
4
5
How often is it OK for your roommate to have company?
Never
Sometimes
Always
Pets Preference
Don't Mind
No Pets
Drinking Preference
Don't Mind
No Drinking
Smoking Preference
Don't Mind
No Smoking
COVID-19 Roommate Expectations
Same as mine
Similar but willing to negotiate differences
No expectations
Do you have a disability?
*
Yes
No
Veteran Status - Have you ever served in the United States Military?
*
Yes
No
What race/ethnicity best describes you?
*
A - Asian American/Pacific Islander/Asian
B - Black/African American/African
C - Hispanic/Latino/Latina/Latinx
D - Native American/American Indian/Indigenous
E - White/Caucasian/European
F - Multi-racial/Multi-ethnic (Two or More)
G - Unknown/Decline to State
What is your current gender identity? (Please select all that apply)
*
Woman
Man
Non-binary
Genderqueer
Prefer not to state
If gender identity is not listed above, please specify:
Emergency Contact Name*
*
Emergency Contact Relation*
*
Examples: Son, daughter, cousin, close friend
Emergency Contact Phone Number*
*
How did you hear about our shared housing program?*
*
Internet search
Referral/word of mouth
Social media
News source
Other
If Referral, please list organization or individual
If Other, please explain
You have a right to obtain a copy of any consumer credit report or investigative consumer report obtained by ALA by checking the box provided below.
I request a copy of any consumer credit report or investigative consumer report obtained by ALA
Date of Birth
*
-
Month
-
Day
Year
Date
Driver License # / State
SSN*
*
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