Second Chance Housing Indy (SCHI) Enrollment Application
Applicant's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SSN
DLN
Do you have a Vehicle?
Yes
No
Vehicle Information
Rows
Model
Make
Year
Color
Type
License Plate #
1
2
3
4
Occupation/Job Title?
Name of Company
Department
What is your monthly gross income? ($)
What is your annual gross income? ($)
Please upload Proof of Income within the last 3 months/Certificate of Employment and Photo I.D
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Number of persons who will occupy the property
Please state the names of the other occupants and relationship to the applicant.
Do you have pets?
Yes
No
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Duration of Occupancy
Reason(s) of leaving / Needing a second Chance
Previous Landlord Name
First Name
Last Name
Previous Landlord Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you been evicted before?
Yes
No
If yes, please explain below:
Have you been convicted of any crime before?
Yes
No
If yes, please explain below:
Have you been convicted of felony before?
Yes
No
If yes, please explain below:
Unit Applying for
*
Please Select
1 bed 1 bath apartment
2 bed 1 bath apartment
3 bed 1 bath apartment
1 bed 1 bath house
2 bed 1 bath house
3 bed 1 bath house
Female shared housing
Male shared housing
Move in date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date to pay the security deposit
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Payment Method
Credit Card
Second Chance Housing Indy Program Agreement
Please read carefully
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Applicant's Signature
My Products
*
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SCHI Enrollment Fee
One-time program enrollment fee to begin the housing placement process.
$450.00
$
450.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Submit
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