Rent Readiness & Housing Stability Program Registration

Rent Readiness & Housing Stability Program Registration

Provide your information to participate in the Rent Readiness & Housing Stability Program. Participation is voluntary and does not guarantee housing placement.
Please read the following information before completing the form: Participation in the Rent Readiness & Housing Stability Program is voluntary and is not tied to lease enforcement or housing eligibility. Completion of this form does not guarantee housing placement.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
SECTION 2: BASIC INFORMATION
Full Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Method of Contact
SECTION 3: REFERRAL SOURCE
How did you hear about this program?
If referred by an organization, please list the name
SECTION 4: HOUSING STATUS
What best describes your current housing situation?

Other
How long have you been in your current housing situation?
SECTION 5: RENTAL EXPERIENCE
Have you ever signed a lease before?
What challenges have you experienced with renting?
Do you currently receive or expect to receive housing assistance?
SECTION 6: PROGRAM READINESS (PRE-ASSESSMENT)
On a scale of 1–5, how confident are you in your ability to maintain stable housing?

1

2

3

4

5

1 is , 5 is Best
What do you hope to gain from this program?
SECTION 7: AVAILABILITY & FORMAT
Preferred program format
Best availability
SECTION 8: CONSENT & ACKNOWLEDGMENT (VERY IMPORTANT)
I understand that participation in the Rent Readiness & Housing Stability Program is voluntary. Participation does not impact lease enforcement, rental rates, housing eligibility, or access to housing assistance. Information collected is used for program improvement and outcome tracking.
I acknowledge and agree
SECTION 9: SIGNATURE
Participant Signature
Date

MonthDayYear
Date
What are your goals for participating in the Rent Readiness & Housing Stability Program?

Rent Readiness & Housing Stability Program Registration

SECTION 2: BASIC INFORMATION

SECTION 3: REFERRAL SOURCE

SECTION 4: HOUSING STATUS

SECTION 5: RENTAL EXPERIENCE

SECTION 6: PROGRAM READINESS (PRE-ASSESSMENT)

SECTION 7: AVAILABILITY & FORMAT

SECTION 8: CONSENT & ACKNOWLEDGMENT (VERY IMPORTANT)

SECTION 9: SIGNATURE