Housing Providers
Name
First Name
Last Name
Business Name
Business Email
example@example.com
Business Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
County of ILF
Which does you home have?
Shared rooms only
Private rooms only
Both shared and private
Shared Room Rate
Private Room Rate
How many people can your home accommodate?
What population are you serving? (select all the apply)
Seniors
Veterans
Men only
Women only
Reentry
Domestic Violence
Mothers with children
Fathers with children
Other
Please upload a few pictures of your set up
Browse Files
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Choose a file
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Are you also interested in landlord referrals?
Yes
No
By submitting this form, you acknowledge and agree to the following: A referral fee will apply for any referrals provided through New Phases Kingdom Solutions Housing program. A formal contract outlining the referral fee structure and terms will be sent and must be signed prior to connecting the referral to your housing program. All referrals will be pre-screened to ensure basic eligibility. You, as the housing provider, will have the opportunity to conduct your own screening and ask any additional questions before the referral fee is due. By continuing, you confirm that you understand and agree to these conditions.
I agree
Submit
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