Client Application Form

Tenant Screening Form
Property Selection
Personal Info
Full Name

First NameMiddle NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Phone Number
Enter a valid phone number for communication.Format: (000) 000-0000.
Email Address
Enter a valid email address for communication.
Are you a citizen of United States?
Are you currently homeless?
Have you received an eviction notice?

How soon do you need a place to live?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Economic Status
Are you currently employed with an active income?
If No, what is your income source?
Average Monthly Income
Income in USD.

Lease Details
Have you lived in shared housing before?
Do you have a background history of violence or behavioral safety issues?
Please identify any factors that may affect your compatibility with other residents.
Are you willing and able to share common spaces and responsibilities?
Are you open to a shared room or do you prefer a private room?

References
Do you have a case manager or parole officer?
If Yes, Please provide the full name of your case manager or parole officer

First NameMiddle NameLast Name
Email Address of Your case manager or parole officer
Enter a valid email address for communication.
Phone Number of Your case manager or parole officer
Enter a valid phone number for communication.Format: (000) 000-0000.
At least one reference is required. Please enter communication details of someone who can be a reference for you.
Full Name of Your Reference

First NameLast Name
Relation
Family, friend, etc.
Email Address of Your Reference
Enter a valid email address for communication.
Phone Number of Your Reference
Enter a valid phone number for communication.Format: (000) 000-0000.

Confirmation
Signature
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Tenant Screening Form