Housing Application
“Complete this form to apply for housing. We will contact you within 24–48 hours.”
PERSONAL INFO
Full Name
*
First Name
Last Name
Date Of Birth “Used for identification purposes only.”
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Housing Needs
MOVE-IN READINESS
*
Immediately
Within 1 week
Within 2 weeks
Just exploring
Exact Desired Move-In Date
/
Month
/
Day
Year
Date
Are you a Veteran
*
Please Select
YES
NO
CURRENT LIVING SITUATION
Where are you currently staying?
Renting
Shelter
Homeless
With family/friends
Own Home
Other
Reason for seeking housing: "Briefly Explain"
*
INCOME
Source of Income
*
Please Select
Employment
SSI
SSDI
VA Benefits
Other
How long have you had your current income source?
Monthly Income (Approximate)
*
Why would you be a good fit for housing with Guiding Light Residences?
EMPLOYMENT STABILITY
Are you currently employed?
Please Select
YES
NO
FINAL SCREENING QUESTIONS
Are you currently substance-free?
Please Select
YES
NO
Do you have any history of violent behavior?
Please Select
YES
NO
Final Agreement: By signing “I understand that Guiding Light Homes provides independent housing only and does not offer medical, clinical, or treatment services. I agree to follow house guidelines if accepted.”
“Submit Application”
“Submit Application”
Should be Empty: