Kingz Haven Intake
Client Information
Client Name
*
First Name
Middle Name
Last Name
Client Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Client Email
*
example@example.com
Address History (Last 90 Days)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Voucher Type
*
CityFHEPS
Section 8
SOTA
FHEPS
SHARES
HASA
NONE
Other
Preferred Borough
*
Brooklyn
Queens
Manhattan
Bronx
Staten Island
Max Rent (if no voucher)
Approved Amount (if voucher)
EX: 2BD $3.058
Number of Bedrooms (Preferred)
*
STUDIO,1,2,3,4
Voucher Expiration / Desire Move Date
*
-
Month
-
Day
Year
VOUCHER HOLDERS ENTER VOUCHER EXPIRATION DATE
Source of Income
*
Employment
Self-Employed
Public Assistance
Pension / Retirement
Child Support
Savings / Assets
Other
Pets
*
Dog
Cat
No Pets
Service Animal / Emotional Support Animal
Other
Back
Next
Required Supporting Documents
Upload your Government ID(s)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload your Income Documents
Browse Files
Drag and drop files here
Choose a file
Last 30-60 Days
Cancel
of
Upload your Voucher Award Letter / Shopping Letter
Browse Files
Drag and drop files here
Choose a file
DSS - 7 or DSS - 7 b ( “ Shopping Letter”) DSS - 7a or DSS - 7c (“Household Share Letter”)
Cancel
of
Upload your Client Consent Documents (If applicable)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload your Household Composition Documents (If applicable)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Caseworker Information
Case Manager Name
First Name
Last Name
Case Manager Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Case Manager Email
example@example.com
Back
Next
How did you hear about Kingz Haven Housing Hub?
*
Please Select
Instagram
TikTok
Google Search
Kingz Vision Website
Referral from a Friend or Family Member
Referral from a Case Manager / Agency
Landlord or Property Owner
Flyer / Advertisement
Previous Client
Other
Who referred you? (Name & organization, if applicable)
Submit
Should be Empty: