• Housing Pre Screening Application 🏡

    Complete this form to assess your eligibility and housing needs.

  • Applicant Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.

  • Current Housing and Referral Details

  • Currently on Supervision?*
  • Willing to Share a Room?*

  • Income and Documentation

  • Income Source*
  • Do you have valid identification, a Social Security Number, and proof of income?*

  • Eligibility and Background Screening

  • Have you ever been convicted of a violent offense?*
  • Have you ever been convicted of a sexual offense?*
  • Are you currently facing any pending legal charges?*
  • Have you ever been diagnosed with a mental health condition?*
  • Are you currently receiving counseling or support services?*
  • Have you struggled with substance use in the past?*
  • Should be Empty: