Emergency Housing Application

  • Please review the eligibility criteria and program requirements above prior to completing the application.

    Applications submitted by individuals who do not meet the eligibility criteria will not be considered.

  • Emergency Housing Application

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  • Format: (000) 000-0000.
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  • Are you currently enrolled in another program?*
  • Gender*
  • Ethnicity*
  • US Citizen?*
  • Are you currently empolyed?*

  • Case Manager Contact

    Case Managers will be contacted as part of the application process.
  • Format: (000) 000-0000.

  • Homelessness

    Must meet the definition of chronic homelessness
  • Are you currently homeless?*
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  • Have you ever been evicted?*
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  • Mental Health History

    This does not make you ineligible for housing assistance.
  • Have you been hospitalized for an emotional or mental condition?*
  • Have you received treatment and/or medication for emotional/mental condition?*

  • Substance Abuse History

    This does not make you ineligible for housing assistance.
  • Do you have a history of substance use?*
  • Ever been treated for any addiction?*
  • AA/NA/GA attendance?*
  • Do you have a sponsor?*

  • Legal History

    This does not make you ineligible for housing assistance.
  • Have you been arrested before?*
  • Is there currently a warrant out for your arrest?*
  • Have you ever been convicted of a crime?*
  • Have you ever served jail/prison time?*
  • Are you on probation or parole?*

  • References

    References will be contacted as part of the application process.
  • Format: (000) 000-0000.

  • Completion of this application does not guarantee housing or supportive services.

  • Should be Empty: