JSTON Rooms For Rent Form

ROOMS FOR RENT FORM

Disclaimer: The information you provide on this form will be kept confidential. Submission of this form does not constitute an approval. Final approval is contingent upon verification of the information provided and meeting program guidelines.
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Are you Male or Female?*

MaleFemale
Name of Sponsor (Company, Organization, Individual or NA)
Photo ID Upload *

Cancelof
PLEASE COMPLETE QUESTIONNAIRE
Are you looking for Private Room or Shared-Room?*

Private RoomShared Room
Who is Applying?*

Military VeteranHomeless AdultIndependent Seniors (55+)Working AdultRe-Entry Adults (62+)Adult w/Fixed or Low IncomeTravel ProfessionalCollege StudentOther
Are you currently homeless?*

YesNo
Do you have a violent criminal history?*

YesNo
Are you being released from an institution?*

YesNo
Are you a registered sex offender?*

YesNo
Are you being sponsored by an organization for rent assistance?*

YesNo
Do you have current monthly Income?*

YesNo
What are your sources of Income?*

Veteran BenefitsEmployed (Self-Pay)SSI BenefitsSelf EmployedPrivate PayFamily AssistanceOther
What is your monthly Income?*

$500 - $1,000$3,000 - $4,000$1,000 - $2,000$5,000+$2,000 - $3,000Other
What is you desired move-In timeframe?*

1-2 Weeks1-3 Months3-4 Weeks6 + MonthsOther
How did you hear about us?

FacebookInstagramLocal AdvertisementProperty SignReferred by a FriendOther
Additional Comments?
Should be Empty:

ROOMS FOR RENT FORM