Initial Service-Enhanced Housing Application

Initial Service-Enhanced Housing Application

Jonnycake Center for Hope offers "service-enhanced housing" which is intended for Jonnycake Center members and other residents who are interested in working with a case manager of family-centered goals to improve their family's quality of life, such as better employment, health care, and educational opportunities. In order to assess the usefulness of Jonnycake's housing, tenants participate in periodic surveys about their family's well-being and meet 2 times per month with a case manager.
Are you, or have you been, a Jonnycake Center member/client?*

YesNo
If yes, what is your client number?
Including yourself, how many adults are in your household (18+)*
How many children are in your household?*
Adult Applicant #1
*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Highest level of education completed
Adult Applicant #2 (if applicable)
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Highest level of education completed
List All Other Household Members
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current Age
Relationship
School
Grade
Is there another household member?*

YesNo
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current Age
Relationship
School
Grade
Is there another household member?

YesNo
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current Age
Relationship
School
Grade
Is there another household member?

YesNo
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current Age
Relationship
School
Grade
Is there another household member?

YesNo
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current Age
Relationship
School
Grade
Is there another household member?

YesNo
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current Age
Relationship
School
Grade
Are you a foster parent or guardian to any children listed above?*

YesNo
Current Residence
What is your current residence?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at this address?*
Do you currently have a section 8 voucher?*

yesno
If yes, for how many bedrooms?
If yes, how much of the rent are you responsible for?
Which housing authority is your voucher with?
Have you ever been evicted?*

YesNo
Have you ever broken a lease?*

YesNo
Are you behind on any major utility bills?*

YesNo
Have you experienced housing instability or homelessness in the last year?*

YesNo
Do you have a car?*

YesNo
Do you have any pets?*

YesNo
If yes, please list the type of pet, breed, and weight of each animal
Employment/Financial
Current Employer
Position/Title
Address of Employment

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor

First NameLast Name
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Starting Date of Emplyment

MonthDayYear
Date
End Date of Employment (if presently employed, please leave blank)

MonthDayYear
Date
Monthly Income
Additional Income

In this section, list any other income you receive per month
Additional Income from additional employment (include name of employer and monthly income)
Other Sources of Income (SSI, SSDI, Child Support, Pension, etc... Please list the source and amount for each additional source of income)
I agree and understand that an aspect of enrolling in service-enhanced housing at Jonnycake Center for Hope includes meeting 2 times per month with a Jonnycake Center case manager. This includes, but is not limited to, setting goals for myself and my family members.
Should be Empty:

Initial Service-Enhanced Housing Application

Adult Applicant #1

Adult Applicant #2 (if applicable)

List All Other Household Members

Current Residence

Employment/Financial

Additional Income