Women’s Independent Housing Interest Form
Jones Community Development Foundation (JCDF) is exploring the need for independent housing options for women who are rebuilding stability, transitioning from hardship, or seeking supportive housing.This form helps us understand interest and need as we plan for future women’s housing programs. Completing this form does not guarantee placement, but ensures you’ll be notified when housing becomes available.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Age Range
18–25
26–40
41–55
56+
What is your current housing situation?(Check all that apply)
Staying with family/friends
Transitional or temporary housing
Homeless or at risk of homelessness
Currently renting
Other
What kind of housing support would best fit your needs?
Short-term (3–6 months)
Long-term (6–12 months)
Independent shared living
Emergency placement
Do you currently have a source of income?
Yes (Employment)
Yes (Benefits or Disability)
No, currently unemployed
Would you be open to connecting with support services (employment, counseling, education, etc.)?
Yes
No
Maybe
How did you hear about Jones Community Development Foundation?
Would you like to receive updates when housing becomes available?
Yes
No
Comments or Questions:
Submit
Should be Empty: