Stayzy LLC Housing Application

Stayzy LLC Housing Application

All information will be kept confidential. Only one application per person.
Things to consider before applying

This is a shared housing living arrangement. Guaranteed Income is required (SSI/SSDI/Organization Pay) Individuals must be work- ready (Private Pay) House Rules are strictly enforced. Stayzy is a drug & alcohol-free environment
Participants Full Name

First NameMiddle NameLast Name
Representative's Name

First NameLast Name
Rep's Organization (ex: DSS, Salvation Army, VA, etc)
Gender
Date of birth

MonthDayYear
Date
Race
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do we have permission to call or text this number to contact you regarding your housing request?
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Current Living Situation

Other
Reason for leaving current living situation?
Please be detialed
Do you have any physical or mobility issues? If yes, please explain below.
Your answer will not disqualify you.
Do you require a Handicap Accessible living environment? If yes, please explain below.
Your answer will not disqualify you.
Are you an ex-offender? If yes, please explain below.
Your answer will not disqualify you.
Are you currently on Probation or Parole? If yes, please explain below.
Your answer will not disqualify you.
Parole or probation officer contact information.
Desired Move-in Date

MonthDayYear
Date
Employment/Funding Status
If you selected unemployed or other please explain your ability to pay participant fee.
Please be detailed.
Place of employment & Job title/description
Monthly Income (USD)
Can you provide proof of income or funding?
Employer name & contact information
Are you willing and able to follow all program rules and respect others?
Personal References (Name, Relationship, Contact Info)
A minimum of 2 people
How did you hear about Stayzy?
Additional Comments
Should be Empty:

Stayzy LLC Housing Application

Things to consider before applying