Good and Faithful Housing Program Application

Good and Faithful Housing Program Application

Please answer each question thoughtfully and accurately to be considered for the program.
Application Details
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Desired Move-In Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How did you hear about Good & Faithful Housing?

Other
Applicant Information
Full Legal Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Social Security Number
Drivers License Number
State Issued
Document Expiry Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contacts
Primary Emergency Contact Name

First NameMiddle NameLast Name
Primary Emergency Contact Relationship
Primary Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Primary Emergency Contact Email
example@example.com
Primary Emergency Contact Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Current Housing Status
Where are you currently residing?

Other
How long have you lived there?
Why are you seeking housing through Good & Faithful Housing?
Rental History
Current/Most Recent Residence Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Current/Most Recent Landlord/Property Manager
Current/Most Recent Landlord/Property Manager Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current/Most Recent Dates of Residency
Current/Most Recent Monthly Rent
Current/Most Recent Reason for Leaving
May we contact your landlord?
Employment & Income
Current Employment Status

Other
Employer Name
Position
Length of Employment
Monthly Gross Income
Additional Sources of Income

Other
Additional Income - Monthly Amount
Program Needs & Goals
How long do you anticipate needing housing through this program?

Other
Please explain (anticipated housing duration)
What goals are you hoping to accomplish while living in the program?

Other
Program Goals - Other (please specify)
Health & Wellness
Do you have any diagnosed medical conditions the Program Manager should be aware of?
If yes, please explain your medical conditions (if none, please write "N/A")
Do you have any diagnosed mental health conditions?
If yes, please explain your mental health conditions
Are you currently receiving counseling, therapy, or mental health services?
If yes, please explain your current services
Do you independently manage your medications and healthcare appointments?
Disability & Accommodations
Do you have a disability requiring accommodations?
If yes, please describe the accommodations needed
Do you require mobility aids?
Mobility aids - other (please specify)
Allergies (food, medication, environmental, pet)
Safety & Trauma History
Have you experienced domestic violence?
Are you currently concerned for your safety?
If yes, please explain your safety concerns
Is there anyone from whom you require protection?
If yes, please explain who protection is needed from and why
Substance Use & Recovery
Do you have a history of substance abuse?
If yes, please explain
Are you currently in recovery?
If yes, how long have you been in recovery?
Are you willing to comply with a drug-free and alcohol-free housing environment?
Community Living & Behavior
How would you describe yourself?

Other
Have you ever participated in shared housing before?
How do you typically resolve conflicts with others?
Do you have a history of anger management concerns?
If yes, please explain (anger management)
Have you ever been asked to leave housing due to behavioral issues?
If yes, please explain (behavioral issues)
Transportation
Do you own a vehicle?
Vehicle Year
Vehicle Make
Vehicle Model
Vehicle Color
License Plate Number
Vehicle State
Do you have a valid driver's license?
Criminal History
Have you ever been convicted of a felony?
If yes, please explain (felony)
Are there any pending criminal charges?
If yes, please explain (pending charges)
References
Reference #1 Name
Reference #1 Relationship
Reference #1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference #1 Email
example@example.com
Should be Empty:

Good and Faithful Housing Program Application

Application Details

Applicant Information

Emergency Contacts

Current Housing Status

Rental History

Employment & Income

Program Needs & Goals

Health & Wellness

Disability & Accommodations

Safety & Trauma History

Substance Use & Recovery

Community Living & Behavior

Transportation

Criminal History

References