Bridgeway Housing Solutions
Housing Application
Application Fee & Deposit Notice:
To move forward with the housing process, a $45 non-refundable application fee is required for all applicants. This fee helps cover the cost of screening and reviewing applications so we can match you with the best possible housing option. If you're approved, a separate security deposit will be required to hold your space.
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Section 1:
Applicant Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Last known address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you applying for yourself?
*
Yes
No
If no, who are you applying for? (Please provide the full name, age, and your relationship to the individual):
Will anyone else be living in the home with you?
*
Yes
No
If yes, please list their names and ages:
Are you the legal guardian or representative for the person in need of housing?
Yes
No
Current Living Situation
How long have you been in this situation?
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Preferred Method of Contact
*
Call
Text
Email
Do you currently have a valid photo ID (state ID, driver’s license, etc.)?
*
Yes
No
Emergency Contact Name and Number:
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Section 2:
Housing Needs
Are you receiving assistance from another housing program or agency?
*
Please Select
Yes
No
If yes, where?
Are you currently working with a case manager?
*
Please Select
Yes
No
If yes, Case Manager Name/Agency
Do you have any transportation needs or limitations? (e.g., need to be near bus lines, walkable area)
Yes
No
If yes, please explain:
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Section 3:
Health & Support Needs
Do you have any physical or mental health needs?
*
Please Select
Yes
No
If yes, please explain
Do you take prescription medications?
*
Please Select
Yes
No
If yes, please explain
Do you require assistance with daily activities?
*
Please Select
Yes
No
If yes, please explain
Are you connected with any support services (medical, mental health, recovery)
*
Please Select
Yes
No
If yes, please explain
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Section 4:
Employment & Income
Do you currently have a source of income?
*
Please Select
Yes
No
What is your monthly income AFTER taxes? (your take home pay)
*
If yes, what is your monthly income AFTER taxes? (your take home pay)
What is the source of your income?(Check all that apply)
*
Employment
Social Security (SSI/SSDI)
Unemployment
Child Support
Housing /Rental Assistance
Public Assistance (TANF, SNAP)
Other source of income
How long have you had this source of income?
*
What is your monthly income from each source you identified?
*
What is your TOTAL monthly income? (from all sources)
*
Do you have proof of income (e.g., pay stub, benefit letter)?
*
Yes
No
Do you receive financial help from family, friends, or another support source?
*
Yes
No
If yes, please explain:
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Section 5:
Legal History
Have you ever been convicted of a misdemeanor or felony?
*
Yes
No
If yes, please briefly explain the charge(s) and year(s):
Have you ever been incarcerated?
*
Please Select
Yes
No
Are you currently on probation or parole?
*
Yes
No
If yes, who is your officer and what county are you reporting in?
Do you have any active warrants or unresolved legal matters?
*
Yes
No
If yes, please explain:
Are you currently involved in any court cases (family court, criminal, civil)?
*
Yes
No
If yes, please provide brief details:
Do you have any current legal issues or probation/parole requirements?
Please Select
Yes
No
Are you subject to any restrictions (e.g., curfews, residency limitations)?
*
Yes
No
If yes, please explain:
Do you have any pending charges that may impact your ability to maintain housing?
*
Yes
No
If yes, please explain:
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Section 6: About Our Lease Terms
At Bridgeway Housing Solutions, our initial lease terms are 3 to 6 months. This does not mean you’ll be asked to leave after that time. Instead, this short-term lease allows us to: Ensure the housing arrangement is a good fit for both you and the household. Offer flexibility as your needs, income, or goals change Protect the safety and stability of the home for everyone. Our goal is to support long-term housing stability. In fact, many of our residents choose to stay beyond their initial lease term and continue building a stable foundation in their home.
Please share your long-term housing and personal goals below:
*
Any special needs, preferences, or concerns?
*
I certify that the information I have provided is true and complete to the best of my knowledge. I understand that the $45 application fee is non-refundable and does not serve as a security deposit. If accepted, I understand a separate security deposit will be required.
*
A $45 non-refundable application fee is required for all applicants.
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( X )
USD
This fee covers screening and does not go toward rent or the security deposit.
Credit Card
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