Partner Housing Intake Form

Partner Housing Intake Form

Thank you for your interest in partnering with Legacy Housing Partners through the No Home Left Empty initiative. This Partnership Intake Form is designed to collect essential information from organizations, property owners, operators, and service providers interested in collaborating to deliver safe, stable, and dignified housing solutions nationwide.This initiative is delivered in partnership with Prudent Management, Inc., bringing together operational excellence in property management with Legacy Housing Partners’ mission-driven housing placement and community impact model.By completing this form, you are expressing interest in a strategic partnership that may include resident placement, property referrals, housing inventory alignment, and/or program collaboration. Submitted information will be reviewed by our partnership team to assess fit, readiness, and next steps.Please provide complete and accurate details to help us efficiently evaluate partnership opportunities and move forward where alignment exists. We appreciate your commitment to expanding access to housing and look forward to exploring collaboration with you.Legacy Housing Partners – No Home Left EmptyWhere Legacy Begins with a Key
Section 1: Partner/Organization Information
Legal Name of Organizaton/Individual Owner*
DBA(if applicable)
Primary Contact Full Name*

First NameLast Name
Title/Role
E-mail*
example@example.com
Phone Number*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website(if any)
Organization Type (check all that apply)*

Individual Property OwnerProperty Management CompanyNonprofit OrganizationDeveloperFaith-Based OrganizationMunicipality/ Housing AuthorityInvestor GroupOther
Please Specify(if other)
Section 2: Service Area Coverage
City/State Where Housing is Located*
You will complete a separate form for multiple homes.
Zip Code(s) Serviced
Is this property located in any of the following?

Opportunity ZonesUrban CoreCRA-Eligible AreaRural AreaUnsureTribal Land
Section 3: Property Identification
Property Name ( if applicable)
Property Address*
Street, City, State, Zip Code
Property Type*

Single-Family HomeApartment Complez ( 20+ units)DuplexTriplex/FourplexTriplex/FourplexSmall Multifamily (5 - 20 units)Group HomeTransitional HousingShort-Term / Furnished HousingTiny Homes / Micro-UnitsOther (describe)
Please Specify(if other)
Year Built (approx)
Total Number of Units/Rooms/Beds at Property
Number of Units/Rooms/Beds Available for Placement
Section 4: Unit Details
Bedrooms/Bathrooms*
Square Footage (approx)*
Maximum Occupancy Allowed*
Accessibility Features*

ADA AccessibleGround FloorRampGrab BarsNone
Furnishing Status*

Fullu FurnishedPartially FurnishedUnfurnished
Utilities Included*

ElectricWaterSewerGasInternetTrashNone included
Section 5: Financial & Leasing Information
Monthly Rent Per Unit/Bed*
Security Deposit Required*

YesNo
Application Fee(if any)*
Put N/A if not required
Lease Term Options*

Month to Month3 Months6 Months12 MonthsFlexibleLong Term(over 12 months)Flexible
Utilities Billed To:*

TenantPartner OrganizationPlacement Agency
Payment Types Accepted

Housing VouchersAgency Master LeaseNonprofit Program PaymentsSelf-PayEmployer HousingOther
Section 6: Placement Eligbility & Preferences
Populations Accepted (check all that apply)*

VeteransFamilies with childrenSingle AdultsSeniorsIndividuals with DisabilitiesReturning CitizensSurvivors of Domestic ViolenceMedically FragileYouth/Transitional Age
Background Criteria*

Criminal History RestrictionsCredit Score minimum (if any)Prior evictions acceptedSex offender restrictions (if applicable)
Pets Accepted*

YesNoService Animals Only
Section 7: Property Status & Readiness
Current Status*

Vacant - Ready NowVacant - Needs Minor RepairsOccupied - Available SoonUnder Renovation
Estimated Date Available*
Last Inspection Date (if applicable)

MonthDayYear
Date
Passed Housing Quality Standards

YesNoScheduledNot Required
Section 8: Document Uploads
Proof of Ownership or Management Authority*

Cancelof
Property Photos (Interior & Exterior)*

Cancelof
Insurance Declaration*

Cancelof
Section 9: Referral & Partnership Terms
How did you hear about No Home Left Empty/Legacy Housing Partners?
Are you open to:

Master LeasingLong-Term PartnershipPortfolio ExpansionRehab-To-Rent CollaborationEmergency Placements
Section 10: Certificatons & Attestation

Partner Certification Statement
I certify that all information provided is accurate and complete to the best of my knowledge. I understand that submission does not guarantee placement and that properties are subject to review, inspection, and program alignment.
I agree
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