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Housing Questionnaire

Housing Questionnaire

Thank you for your interest in Bonavis shared housing. Our low tox homes are smoke free, drug and alcohol free and pet free. Completion of this form does not guarantee housing. We review each form to ensure a safe and respectful shared living environment for all members.

18Questions

1
Full Name* This field is required.Applicant
First Name
Last Name
2
Phone Number* This field is required.
Area Code
Phone Number
3
Email
example@example.com
4
Gender* This field is required.
Female
Male
5
Which housing option best fits your situation?* This field is required.
Independent veteran (male or female)
Woman seeking housing
Woman with children
Senior (55+)
Working professional
Re-entry citizen (recently released)
Other
6
When do you need housing?* This field is required.
Immediately
Within 14 days
Within 30 days
Just exploring options
7
What is your current living situation?* This field is required.
Renting but lease ending soon
Staying with friends/family
Recently evicted
Living in temporary housing
Currently homeless
Transitional program ending soon
8
What led you to seek shared housing at this time?
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Large
Normal
Small
Ok
Ok
9
Are you comfortable sharing common spaces such as kitchen, bathroom, and living areas with others?* This field is required.
Yes
Yes, but I prefer limited interaction
I prefer private living
10
What type of room are you seeking?* This field is required.
Private room
Shared room
Either option
11
Are there any situations that could make shared housing difficult for you?
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Large
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Small
Ok
Ok
12
Can you pass a basic background screening if required?* This field is required.
Yes
Possibly (would like to discuss)
No
13
Are you currently employed or receiving stable income?* This field is required.
Full-time employment
Part-time employment
Veteran benefits / pension
SSI / disability income
Unemployed but actively seeking work
Other
14
How much income (after taxes) do you bring home?You will be required to show proof of income prior to being accepted.
less than $1,499/month
$1,500-$2,000/month
$2,000–$2,499/month
$2,500–$3,499/month
$3,500–$4,499/month
$4,500–$5,499/month
$5,500–$6,499/month
more than $6,500/month
15
Have you ever been asked to leave housing by a landlord, roommate, or program? If yes, please briefly explain.
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Large
Normal
Small
Ok
Ok
16
How did you hear about Bonavis housing?* This field is required.
Facebook
Craigslist
Referral
VA
Social worker
Friend
Other
17
Is there anything else we should know about you?
18
Enter the message as it's shown
Should be Empty:

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