Pre-Application
Use the form below to check housing availability in your preferred location. Submission of this form does not guarantee placement. All requests are reviewed individually. If availability exists, our team will contact you by email with next steps, including application and verification instructions. A $300 non-refundable community fee is required only after verification and approval. Verification is completed through third-party services at no cost to you. Please allow time for review. Do not submit multiple requests for the same location.
Applicant Information:
Full Name
*
First Name
Last Name
Do you have a caseworker?
*
Please Select
Yes
No
Phone Number
*
Format: (000) 000-0000.
E-mail [Note: Email is the primary method for billing and program communication. Invalid or missing contact information may result in disqualification.]
*
Confirmation Email
email@yahoo.com
Caseworker/Advocate or Organization Name
*
Caseworker's Phone Number
*
Format: (000) 000-0000.
-
Area Code
Phone Number
Caseworker's E-mail [Note: Email is the primary method for billing and program communication. Invalid or missing contact information may result in disqualification.]
*
Confirmation Email
email@yahoo.com
Are you at least 18+ years old and over?
*
Yes
No
Gender
*
Male
Woman
Non-binary
Prefer not to say
Another identity (please specify)
Do you have children (under the age of 13 years old)?
*
Yes
No
What is your occupancy type?
*
Individual
Family
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Housing Information
Please provide your preferred location and the type of housing you need. This helps us match you with available options.
Current Housing Programs
*
Shared Living
Location Selection
*
Please Select
Arizona
Indiana
Current Living Situation *Multi-Choice*
*
Staying in a temporary shelter
Staying with friends or family (temporary)
Living in a vehicle
Living outdoors / unsheltered
At risk of losing housing
Other, (please explain by entering text)
Length of Current Situation
Please Select
Less than 1 month
3-6 months
6+ months
How long have you been without stable housing?
Move-In Timeline
*
Please Select
Immediately
1-3 Months
3-6 Months
Flexible
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Income Source
Primary Income Source
*
Employment Full-Time
Employment Part-Time
Social Security/ Disability
Other (please specify)
Monthly Income Estimate
*
Enter an amount
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Personal Background
This information is for eligibility review purposes only and helps us ensure a safe housing environment.
Have you ever been convicted of a felony?
*
Yes
No
Please explain...
*
Are you currently on probation or parole?
*
Yes
No
Please explain...
*
Have you used illegal drugs in the past 12 months?
*
Yes
No
Please explain...
*
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Referral Source
How did you hear about us?
*
Please Select
Newspaper
Internet
Magazine
Social Media
Referral/ Friend/ Family
Outreach Program/Caseworker
Other
Please Specify
*
Will you be willing to recommend us?
Yes
No
Maybe
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Terms and Agreement
Please review the information below. Checking the box indicates that you understand the process and next steps, including the required security deposit. I understand the terms and requirements of the Harmony Homes Assistance Program.
Acknowledgement
*
I understand that submission does not guarantee housing placement. I acknowledge that Harmony Homes will contact me after review. I have provided the correct email and phone number for billing and communication.
Please verify that you are human
*
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