Homebase Transitional Housing Program Application Guide
Fernhurst YWCA is a beloved community. We provide a temporary and supportive residence where gifted women live and work. Applicants must meet basic eligibility criteria to be considered for an interview. T. (808) 941-2231 F. (808) 945-9478 Fernhurst YWCA: 1566 Wilder Avenue Honolulu, Hawai'i 96822
HOW TO APPLY
Step 1 - Meet ALL Basic Eligibility
Single Female
Resident of Oahu for the last 3 months, consecutively
Homeless, imminent homelessness, and/or having trouble covering living expenses & basic needs
Actively employed, actively job searching and/or contract/gig work
Free from chemical dependence and substance abuse and consent to random urinalysis/breathalyzer testing
Able to commit 2 hours per week of community service
Commit to working toward self-sufficiency and economic advancement with end goal of permanent housing
Able to commit to saving a portion of gross income into a Moving On Account for the purposes of building a financial safety net
Able to live unassisted
Step 2 - Complete Application
Step 3 - Submit Complete Application
Fax: (808)945-9478 or Email: fernhurst@ywcaoahu.org or Hand-deliver If you plan to hand-deliver your materials, please notify us in advance to schedule an appointment by calling 941-2231, Press 0
Step 4- We will contact you for a phone meeting to verify your eligibility
Step 5 - You will come in for an in-person meeting
Please bring the following documents
Check all that apply if currently receiving and bring documentation of benefits
Welfare (TANF)
Food Stamps Subsidy
Section 8 Subsidy
Child Support
Social Security
Child Care Subsidy
Unemployment/Disability
Questions: Contact Housing Manager at 808-941-2231, x303, fernhust@ywcaoahu.org
Back
Next
Homebase Transitional Housing Program Application Contact Information
Full Name
DOB
Cell Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
How did you hear about Fernhurst?
Social Services Referral
Friend/Family
YWCA Network
Internet
Case Manager
Other
Agency Name
Case Manager Name
Case Manager Phone Number
Ethnicity
Hispanic
Non-Hispanic
Prefer not to say
Ethnicity (Check all that apply)
Native Hawaiian
African American
Hispanic
Asian
Native American/ \Alaskan American
Pacific Islander
White
Black
Other specify
Gender
Background (Check all that apply. All information is kept confidential and for program use only to provide relevant services)
Ex-Offender/Re-Entry/Furlough
In Recovery from Substance Abuse
Currently Homeless
At-Risk of Homelessness
Living with a disability
Emancipated foster youth
Other specify
Highest Education Level Completed
8th Grade
High School Diploma
GED
2-Year Degree
4-Year Degree
Masters or Doctorate
Other specify
Federal / Military Status
Not Applicable
Federal Employee
Military
Veteran
TANF Eligibility
Are you at least 18 years old?
Are you a US Citizen? or a permanent legal alien > 7 years?
Have you lived on Oahu for the last 3 months?
Do you have any children (of any age)
Do you have any children that you provide with financial support?
How many people are in your household? Count those who are.
Employment
Are you currently employed?
What type of employment do you currently have? (Employee, Contractor, gig, other)
Have you been continuously working for the past 2 months?
How many hours a week do you work on average?
What is your hourly wage or monthly salary before taxes?
How much do you currently have in Savings?
Is any other income coming into your home?
Explain the other income:
How much debt do you have? Credit cards, loans, restitutions, etc.
Are you able to work and seek employment?
What company or employer do you currently work for?
Back
Next
Public Assistance
Cash assistance? (Welfare, VA, Social Security)
Food Stamps
Child Support
Public Housing or Section 8 Housing
Child Care Assistance
Public Health Benefits (Quest/AlohaCare)
Are you receiving any other form of public assistance?
Other specify
Public Assistance
Are you able to serve dinner from 5:00-7:00 pm once per week?
Are you free from chemical dependence and substance abuse?
Are you able to live unassisted in a community environment?
Are you currently at risk for domestic violence?
Case Manager (If Applicable)
Program Services
Identify the most important subjects related to your successful transition into permanent housing
Rental Subsidy / Affordable Housing
Budgeting and Financial Planning
Basic Computer Training / Job Skills
Stress and Time Management
DV Intervention or Counseling
Child Care Assistance
Overcoming Criminal Background / Incarceration
Other specify
Back
Next
Briefly explain your short-term goals (30-90 Days)
Briefly explain your long-term goals
Disclosure, Authorization, & Consent
The YWCA of O'ahu is committed to compliance with all local, state, and federal civil rights and human rights laws that prohibit discrimination in providing educational and housing opportunities. The YWCA does not discriminate against any applicant or participant on the basis of race, color, religion, creed, national origin, marital status, and familial status with regard to public assistance, physical handicap, mental handicap or affection preference. The YWCA of O'ahu does provide reasonable accommodation for people with disabilities. Reasonable accommodation in rules, policies, practices and services will be allowed to give people with disabilities an equal program, provided such accommodations do not impose undue hardship. Applicants or program participants with disabilities seeking reasonable accommodations must contact Fernhurst Residence Manager to make an accommodation request. I understand that the application for the Homebase transitional housing program includes a personal interview. Should my application be accepted, I agree to be bound by the policies of YWCA of O'ahu and to refrain from prohibited behaviors in the performance of my services on behalf of the YWCA of O'ahu. I understand the YWCA of O'ahu is not obligated to providea placement. I understand that Fernhurst YWCA is shared housing in a community environment. If accepted, I agree to comply with the standards, policies and procedures provided by the YWCA of O'ahu. I understand that violations of these policies can result in an immediate exit from the program and/or facility. I verify that the information in this application is true and correct. I hereby grant permission to the YWCA of O'ahu to seek the release of information from sources reported in this application.
Applicant Print Name
Date
/
Month
/
Day
Year
Date
Applicant Signature
Submit
Should be Empty: