HIP Transitional Housing Application

TRANSITIONAL HOUSING APPLICATION

Dear Applicant,

Please complete and submit this application to apply for the Transitional Housing program of Housing Initiatives of Princeton. Answer all questions; if a section does not apply to you, please write "N/A."

We maintain a waitlist of eligible applicants and conduct interviews when a unit becomes available. You may be asked to supply more information or clarification.

If any details of your application change (mailing address, email, income, family size, phone numbers), please let us know via email so that we can reach you when a unit becomes available.

Thank you for applying.

Lori Troilo, Executive Director

info@housinginitiativesofprinceton.org

33 Mercer Street, Princeton, NJ 08540

Please answer all questions in order for your application to be considered. If a section does not apply to you, please write "N/A".
Name*

First NameLast Name
Phone*
Email*
example@example.com
Street Address current or most recent*
City*
State*
Zip*
Date of Birth*

MonthDayYear
Date
Age*
Gender*

Please list all other household members and their relation to you (spouse, child, etc)
Household Member 1
Would you like to add another household member?

YesNo
Household Member 2
Would you like to add another household member?

YesNo
Household Member 3
Would you like to add another household member?

YesNo
Household Member 4
Would you like to add another household member?

YesNo
Household Member 5

Current Household Income (Include income from all adult household members) *

	Household Member	Frequency of Payment (weekly, every 2 weeks, monthly)	Amount
Job 1 (Include Job Title in Household Member box)
Job 2 (Include Job Title in Household Member box)
Job 3 (Include Job Title in Household Member box)
Social Security or Disability
Child Support
Unemployment
SNAP, LIHEAP, TANF, Childcare vouchers, other Public Assistance
Other

Current Debt (Include all debt for all household members)

	Description / Type	Amount Owed
Credit Card
Loan (specify type)

Household Expenses: Include all monthly household expenses like rent, utilities, phone, food, etc. for ALL household members.*

	Monthly Amount	Describe "Other" here
Current Rent
Utilities (electric/gas/water)
Communication (phone, internet, TV)
Food
Transportation (Car, Gas, Insurance, etc.)

Housing Situation
Tell us a bit about your current situation including your current housing circumstances.*
What are your goals for you and your family while in HIP Transitional Housing?*
Any additional information you would like us to know?

Personal Information
High School Diploma or GED*

YesNo
Year of Graduation or receipt of GED
Further Education

Technical CertificateAssociate DegreeBachelor Degree
Field or Major
School, Institute, or College
Years attended
Degree earned

YesNo
Post-secondary coursework (community college, classes, job training programs, ESL classes, computer classes, etc.)

Professional and/or Personal References

For example, current/former employer, teacher, clergy member, etc. The reference may not be a family member.
Reference 1*
Reference 2*

I (We) certify that all statements made on this application form have been examined by me and are true, correct and complete to the best of my knowledge and belief. I understand that HIP may use this information to verify the facts stated in this application and to perform credit, reference and/or criminal background checks as part of this application. I understand that the filing of this application does not in any way bind HIP to reserve or assign a transitional housing unit to me.
Applicant*

Clear
Date Signed*

MonthDayYear
Date
Co-Applicant (if applicable)

Clear
Date Signed

MonthDayYear
Date
Should be Empty:

Personal Information