Pre-screening questionnaire
Name
First Name
Last Name
Email
example@example.com
What is your desired move-in date?
How long do you plan to stay?
3-6 months
6-12 months
1+ year
Unsure
What do you do for work?
What is your estimated monthly income?
Can you provide proof of income?
Yes
No
Do you currently receive any of the following income or assistance benefits? (Check all that apply)
SSI
SSDI
Veteran Benefits
Social Security Retirement
Employment Income
Housing Assistance
SNAP/Food Assistance
None
Other
Have you ever been evicted?
Yes
No
Are you willing to complete a background check?
Yes
No
Have you ever been convicted of a felony or misdemeanor that may affect resident safety or shared community living?
Yes
No
Are you currently required to register as a sex offender?
Yes
No
If yes, please briefly explain any relevant criminal history, including dates and circumstances.(Paragraph answer)Criminal history does not automatically disqualify applicants. Applications are reviewed individually with consideration for community safety, rehabilitation, and housing suitability.
Do you smoke or use any substances?
Yes
No
Are you comfortable with shared living and following house rules?
Yes
No
Do you plan to have overnight guests?
Yes
No
Please confirm the following statement: I certify that the information provided is true and complete to the best of my knowledge. I understand that false or misleading information may result in denial of housing consideration.
I Agree
I Do Not Agree
Completion of this questionnaire does not guarantee housing placement.
Submit
Should be Empty: