Housing Application Form

Name*

First NameLast Name

Phone Number*

Email*

example@example.com

What is your current living situation?*

Are you currently pregnant?*

YesNo

What is you monthly budget? If you are inquiring about our Single family & Children only, our private suites start at $1300 with everything included (utilities, wifi, etc)*

Do you have any children that will be staying with you? If so, how many? How old are they? What is their gender? Will they be living with you full-time or will there be shared custody? *

What city are you looking for housing in, and are you flexible with this?*

Our program requires an administrative fee and first month's rent to enter. Are you able to provide requirements to move in? Please note: No animals allowed on premises.*

All of our individuals are subject to background check. At Pathway To Humanity LLC, everyone is treated like family. We believe in honesty, integrity, safety, and compassion. Please disclose, if any, crimes that may appear on a criminal background check.*

What is the best method and time to contact you for intake process once there is a private room available? *

Are you independent? You or you children have mobility limitations? Please disclose below.*

Once you enter the new phase for applying, you will receive an intake form. You have 48 hours to compete the intake form or your spot will be offered to the next candidate and you will be placed at the bottom of the waiting list for this home. Please acknowledge that you have read, and understand the urgency in your prompt response for this suite.*

How soon are you looking to transition in one of our homes? Please provide a date.*

After you speak with a team member, you will be able to set up a tour of the home and learn new steps. Please have proof of income and a copy of your ID for your client file if accepted. Will you be able to provide that?*

The information I have provided is, to the best of my knowledge correct and I agree to update my information should any changes occur.

Signature