Request for Housing Advocacy and Apartment Listings -

Request for Housing Advocacy and Apartment Listings

A General Request for Information and Referral
*** Please note we do not have any funding to provide financial assistance.

*This is an Information & Referral form, and not an Intake to become a consumer of TRI. Depending on your questions and situation, our front desk staff may be able to assist you with providing general information. If you find that you need further assistance or guidance you may then be directed to complete an Intake Packet and assigned to the Housing Advocate.

As a non-profit funded by NYS Education Department's Adult Career and Continuing Education Services-Vocational Rehabilitation (ACCES-VR), we are obligated to collect the following information for funding purposes.

Each question with a * must be answered.

If you are having difficulty completing this form, please call the front desk during regular business hours (M-F, 9am-5pm EST) to assist you: 1-845-452-3913
Date of Request*

MonthDayYear
Date
Your information will remain confidential within Taconic Resources for Independence, Inc. (TRI) staff and our funders from NYSED ACCES-VR.
What is your Legal name:*

FIRST NAMEMiddle InitialLAST NAME
Prefered Name/ Nick Name?
This is optional
Pronouns:*
examples: he/him; she/her; they/them
What is your Date of Birth?

MonthDayYear
DOB
How old are you?*
Some apartments are age 55+ only or age 62/65 only
Your Phone number with area code*
Is your phone number a:*

Mobile/Cell phoneHouse/Land LineN/A - someone else's because i don't have a phone
If the phone number is not your's please tell us whose number it is:
name and title
Your email address*
example@example.com
Complete Mailing Address*
Be sure to include Street #, Street Name, Apt #, City, NY and Zip code
What are your perfered methods of communication?*

Phone callEmailI will need an American Sign Language Interpreter
If you don't speak English, what language interpreter do you need?
Example: Spanish
If this address is also your current Physical address, check the box below

Yes, this is also my Mailing address
Select the category(s) that your Disability falls under:*

Cognitive (examples: epilepsy, learning disability, Autism, TBI)Mental Health (examples: emotional/behavioral disabilities, ADHD)Physical (example: back injuiry, cerebral palsy, other environmental related)Sensory (blindness, low vision, deafness, hard of hearing, other)
It is optional to provide specific detail of your disability:
This information helps staff to accommodate you
Are you the Head of your Household:*

YESNO
How many people live in your houshold, including yourself?*
type 1 if it's just you.
How many bedrooms do you need? The minimum:
What is your marital status?*

SingleMarried (even if you are separated)DivorcedWidowed
Housing Status: What type of housing are you currently living in?*

Temporary Shelter (homless shelter)Institution (Nusing Home/Rehab)Dependent on Family/Friend (lives with)Assisted Living FacilityNo Shelter- sleep on street/ in car/ HomelessSubsidized Rental Property (based on income)Unsubsidized Rental PropertyHomeownerGoing through Foreclosure
Your current total monthly Income:*
SNAP is not income. Type "0" if this question doesn't apply to you.
What is your current Source(s) of Income? Check all that apply- what you are currently receiving now?*

None - $0UnemploymentNYS Disability Benefits (this is not social security)Workers CompensationSSI - Supplemental Security IncomeSSP- State Supplemental ProgramSSDI - Social Security Disability Insurance (based on your work history)Survivor's Social Security BenefitsDependent Benefits (Soc. Sec.)Pension -RetirementSocial Security *Retirement benefitsVeteran's Benefits/ Pension/Aid & AttendanceChild Support PaymentsSpousal SupportRenteal/Boarders/Lodgers IncomeNo Fault Insurance BenefitsPublic Assistance - Cash Assistance from DCFS (DSS)Wages/Earnings
What type of Housing issue are you currently having?*

It is not physically accessibleI will be on the street if not given emergency housing resources now (*You will be redirected to DCFS/DSSI am behind in rent, and i am expecting to be served an eviction notice.I was served an Eviction, and i ahave the eviction noticeDiscrimination based on my disability, source of income, age, gender, and/or orientation.
Do you currently have an active Section 8 Housing Choice Voucher?*

YESNO
If not, have you applied?*

YESNO
IF, "Yes", when was the last time you confirmed your Section 8 Status?*
If you can't remember the date, enter the month & year or season and year.
If you are having difficulty with the Section 8 Program, please explain:
If you are planning to move, what area in Dutchess County NY do you want to live in?
Our advocate will send you a list of places she is aware of for those areas.
Are you looking to move to a different County in NY? If so what County and town/city?
Are you dependent on Public Transit? (eample: live near Bus route):*

YESNO
Do you require a roll-in shower bench?*

SHOWER- yesI need a bench for a TUBNO, I do not require a bench at all.
Are you able to transfer to a shower bench?*

YESNO
Do you need an audio/vision accessible unit?*

YESNO
Do you have a Service Animal?*

YESNO
Will you be willing to accept a unit above ground level?*

YESNO
Will you require an elevator?*

YESNO
Some apartment complexes require proof of citizenship status. Do you currently have the following documents:
Picture/State ID:*

YESNO
Social Security Card?*

YESNO
Birth Certificate?*

YESNO
Is there anything else you need the housing advocate to know, or anything else you may need assistance with?*
If you need assistance applying for Social Security Disability - go back to the website to register for an upcoming workshop and submit a request benefits counseling
Based on the information you provided above, our housing advocate or administrative support staff may email you helpful information on the advocate's behalf within a few business days.

Be sure to check your email's junk or spam folder.

You may call the housing advocate if you haven't received a response after 10 business days: 845-452-3913 ext. 116
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