Housing Program Application

Full Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Please enter a valid phone number.

Date of Birth*

Date

Target Date to Move In*

MonthDayYear

Room Preference (Based on Availability)*

Private RoomShared RoomNo Preference

Employer

Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Business Phone Number

Please enter a valid phone number.

E-mail

example@example.com

Been convicted of a felony? *

YesNo

Describe:

Been evicted from a rental? *

YesNo

Describe:

Defaulted on a lease?*

YesNo

Describe:

In case of emergency, please notify:*

First NameLast Name

Emergency Phone Number*

Please enter a valid phone number.

Relationship:*

I certify that, to the best of my knowledge, all information provided in this application is true, accurate, complete, and correct as of the date submitted. I understand that providing any false or misleading information may result in disqualification from participation in the New Horizons Living Housing Program or removal from consideration.

I acknowledge that this application does not guarantee acceptance or placement within the program. I understand that New Horizons Living may receive multiple applications and reserves the right to select participants based on eligibility, program criteria, and overall fit.

I authorize New Horizons Living and its representatives to verify any information provided in this application, including background or reference checks, as part of the evaluation process.

Do you read this Agreement and agree to the terms and conditions*

YesNo

Where did you hear us?*

Signature*

PROGRAM PARTICIPANT AGREEMENT

Applicant History

Employment (If Applicable)

Background Info

Personal Info

Consent to Verification of Other Information