My Residential Journey Boarding Home Housing Waitlist

Boarding Home Housing Waitlist

Complete this form to join My Residential Journey housing waitlist. Submission does not guarantee placement.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Desired Move-in Date*

MonthDayYear
Date
SharedPrivate
30 to 90 days3 to 6 months6 months or longerOther
Current Living Situation
YesNo
YesNo
YesNo
YesNo
EmploymentSSI or SSDIVeteran benefitsOther
Waitlist Disclosure

** Please note that submitting this form places you on the interest waitlist only. Placement depends on availability, eligibility, and program fit. Submission does not guarantee housing.**
Should be Empty: