HOUSING PROGRAM ELIGIBILITY FORM
For Housing Projects that will be receiving referrals via OneHome/Coordinated Entry. This is in accordance with the Coordinated Entry changes that will go into effect on May 5th, 2025. Please contact the MDHI Coordinated Entry team with any questions about these changes.
Your Name
*
First Name
Last Name
Email
*
Agency Name
*
Program Name (as it appears in HMIS)
Household Type
Adult
Family
Young Adult
Any
Family Size Limit (maximum # of people per family)
1
2
3
4
5
6
7
8
9
10
Age Requirement/Restrictions
18-21
18-24
18+
55+
62+
Chronic Homelessness Requirement
Yes
No
Any Disabling Condition Requirement
Yes
No
HIV/AIDS Requirement
Yes
No
Mental Health Requirement
Yes
No
Substance Misuse Requirement
Yes
No
Veteran Requirement
Yes
No
Gender Requirement
Female
Male
Transgender
Any
Income Requirement
Yes
No
Please describe
Experiences in the Criminal Justice System (former and/or current)
Yes
No
Foster Care
FUP Eligible
Yes
N/A
Open Child Protective Services Case
Yes
N/A
Receives Services in a Specific County or Municipality - This must be an eligibility requirement as documented in your MOU or funding requirements, NOT a preference.
Yes
N/A
Which County or Municipality?
Other Eligibility Requirements -
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