Accessibility First Housing Connector Application

MaxHousing, a nonprofit agency, works to provide accessible housing for people with mobility disabilities. We know how difficult it is for people in need of accessible and affordable housing in Northeast Ohio to find it. The Housing Connector is meant to bring together people needing accessible rental housing with existing accessible units. Filling out the application is the first step in the process.

For more information about the Accessibility First Connection Program call: 216-231-2771 or email: info@maxhousing.org.

Full Name:*

First NameLast Name

Phone Number:*

Please enter a valid phone number.

Email Address:*

example@example.com

Current Address:

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Preferred Method of Contact:

CallEmailMail

Number of people in household:

In order to qualify for the housing this service will offer, the renter or a member of the household will be required to have a qualifying disability such that they will benefit from living in an accessible unit.

Do you or a member of your household have a qualifying disability?*

YesNo

The following questions pertain to the individual with a qualifying disability to help identify an appropriate apartment/unit.

Age:

Under 1818-6465+

Does the individual use a wheelchair?

Always / Almost AlwaysSometimesRarely / Never

Does the individual use other mobility aides?

Always / Almost AlwaysSometimesRarely / Never

How did you hear about MaxHousing's Accessibility First Housing Connector?

All information gathered is for MaxHousing's Accessibility First Housing Connector only. Information will not be given to Property Owners or Managers or other entities without consent from the applicant.

Please verify that you are human*

'sheet'