Aliveness Project Housing Programs Application

Housing Programs Application

January 2025
Aliveness Project’s mission is to provide equitable housing options for individuals living with HIV/AIDS throughout the state of Minnesota (and St. Croix or Pierce County in Wisconsin). Aliveness Project’s Housing Programs seek to house single adults, couples, and families living with and affected by HIV/AIDS who are unable to afford market rate housing costs through several subsidies. This application provides Aliveness Project Housing Staff with the initial information necessary to determine eligibility, and to prioritize applicants.

Submitted applications do not guarantee acceptance to program, program staff will make determinations based on client eligibility and program capacity.

For followup once this form is submitted please reach our secure voicemail box at

612-822-7946 Extension 269 or
housingapps@aliveness.org
For applications to be properly considered please include the following.
1. Proof of Income
  - Tax Returns, Paystubs from a job
  - Award Letter from Social Security Administration (SSA)
  - Award Letter from local county benefits office General Assistance (GA)
  - Minnesota Family Investment Program (MFIP)
  - Child Support Statements, &/or Personal Statement of Assets
2. Proof of HIV/AIDS Status (At a Glance, Lab Report with Name, or MN-ITS showing Program HH).
3. Proof of Insurance (Copy of Insurance Card or MN-ITS) print out.
4. Identification documents recommended but not required.
Please add your files here.

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Personal Information

How we can identify you, and get in touch...
Name*

First NameLast Name
Aliveness Project Member Number*
If not a member please write N/A
Social Security Number*
If no SSN please write N/A
Date of Birth*
Gender*
Pronouns*
Do you currently have an ID?*

YesNo
Phone Number
Email
example@example.com
Is there someone else we should reach out to if we cannot get ahold of you during this application process? Alternate contact name:
Name of Alternate Contact
Alternate Contact Phone Number
Phone number
Are they aware of your HIV/AIDS status

YesNo
Housing Information

This gives us context about your situation...
If unhoused, where did you sleep last night?*

Homeless ShelterHotel or MotelA friend or family member's homeA place not meant for human habitationOther
If housed...

What is your current address?
Street address
City
State
Zip Code
Have you ever received assistance from an Aliveness Project Housing Program?*

YesNo
If yes what year(s)?
Do you have any outstanding rent or utilities owed?*

YesNoUnsure
If yes, how much and what type of bill?
Do you require an apartment with accommodation/modification for a physical disability?*

YesNo
If yes, please describe accommodation needed...
EX: I need an elevator due to arthritis in my hips
Household Information

Please list everyone who will be living in the home together.
First Name   Last Name      Date of Birth      Monthly Income
First Name   Last Name   Date of Birth      Monthly Income
First Name   Last Name   Date of Birth      Monthly Income
First Name   Last Name   Date of Birth      Monthly Income
First Name   Last Name   Date of Birth      Monthly Income
First Name   Last Name   Date of Birth      Monthly Income
First Name   Last Name   Date of Birth      Monthly Income
Income Information

Please tell us about your income sources
Please list all income sources for everyone in the household.

Earned IncomeGeneral Assistance (GA)Minnesota Family Investment Program (MFIP)Supplemental Security Income (SSI)Social Security Disability Insurance (SSDI)Retirement, Survivors, and Disability Insurance (RSDI)Child SupportOther
Please list total monthly income for household*
Its important for us to know this to make determinations on program eligibility.
Case Management Information

Please let us know who else is on your care team...
HIV Case Manager
Name and Agency
Email
example@example.com
Phone Number
Please enter a valid phone number.
Social Worker
Name and Agency
Email
example@example.com
Phone Number
Please enter a valid phone number.
Housing Case Manager
Name and Agency
Email
example@example.com
Phone Number
Please enter a valid phone number.
Other Supportive Staff

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Legal System Involvement

Aliveness Project aims to provide equitable opportunities for individuals who have been charged with an offense. We do not use this question to screen out individuals, rather, gain insight on how to best serve each client. Aliveness Project staff have no control on the external housing market, and may recommend a placement with a Permanent Supportive Housing (PSH) provider if a placement in the community setting is unable to be obtained due to barriers.
Please describe past or present legal system involvement...*
Description of Charges, Level of Charges, Date of Charge, and Location.
Have you ever been convicted in an eviction judgement?*

YesNoUnsure
Are you currently working with a probation or parole office?*

YesNo
If yes, please provide their contact information

NameAgency
Email
example@example.com
Phone Number
Please enter a valid phone number.
Do you consent to Aliveness Project staff completing a background check through Minnesota Court Records Online (MCRO)?*

YesNo
I verify that the information on this form is accurate.*

Clear
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Non-Discrimination Policy

Aliveness Project operates in accordance with federal, state, and local housing laws. Aliveness Project will not discriminate on the grounds of age, race, color, creed, religion, sex, disability, national origin, familial status, sexual orientation, the presence of any sensory, mental, or physical handicap, or the use of a trained guide dog and/or companion animal by a blind or deaf person. When requested, reasonable accommodations will be provided to ensure equal opportunity for a person with a disability to use and enjoy a dwelling through Housing Programs at Aliveness Project. Application Developed January, 2025
Should be Empty:

Housing Programs Application

Personal Information

Housing Information

If housed...

Household Information

Income Information

Case Management Information

Legal System Involvement