• SAFE HAVEN RENTALS L.L.C. NATIONWIDE PROGRAM APPLICATION

  • APPLICATION INFORMATION

  • Who is completing this application?*
  • Format: (000) 000-0000.

  • Income and ID verification will be sent in a separate email to the address provided above after this application is submitted. You must complete and return the verification to continue being considered. Applications are reviewed on a first-come, first-qualified basis, and your Income and ID verification is required for program consideration.

  • PROGRAM INFORMATION

  • Which program are you applying for?*

  • PROGRAM ACCOMMODATIONS

  • PROGRAM ACCOMMODATIONS*

  • PRIMARY APPLICANT INFORMATION

  • Date of Birth:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Applicant's Gender:*
  • Format: (000) 000-0000.
  • Gender of Emergency Contact:*
  • Are you a Veteran?*

  • PROGRAM PLACEMENT INFORMATION

  • *

  • If yes, please list all additional household members & Minors: (After application submission, be sure to upload the minor's birth certificate to verify)

  • CURRENT LIVING SITUATION

  • Where are your current living arrangements?
  • *
  • 0/0
  • Have you ever been evicted?
  • *

  • INCOME & EMPLOYMENT

  • Do you currently have income?*
  • Source of Income:*

  • BACKGROUND INFORMATION

  • Do you currently have any pending legal charges?*
  • Are you currently on probation or parole?*
  • Do you have any history of violent behavior that may affect shared living placement?*

  • HEALTH & SUPPORT INFORMATION

  • Do you have any medical conditions, disabilities, or mental health concerns we should be aware of for housing support purposes?*
  • Are you currently receiving treatment or support services?*

  • SHARED LIVING COMPATIBILITY

  • Are you comfortable living in a structured shared living environment?*
  • Are you willing to follow all program rules and requirements?*
  • Do you agree to respectful behavior toward neighbors, managers, and other participants?*

  • APPLICANT INFORMATION RELEASE AUTHORIZATION

  • Safe Haven Rentals may be unable to provide housing to every qualified applicant due to program availability, eligibility requirements, location, household composition, or other factors.
  • If Safe Haven Rentals is unable to offer you placement, we may be able to refer you to another housing provider, landlord, organization, or housing program that may better meet your needs.
  • By authorizing the release of your information below, you give Safe Haven Rentals permission to share the information you voluntarily submitted during the application and onboarding process for the sole purpose of assisting you in obtaining housing.
  • The information that may be shared includes, but is not limited to:
    • Your completed application
    • Contact information
    • Phone consultation notes
    • Valid government-issued photo identification
    • Income verification and supporting documentation
    • Employment information
    • Household information
    • Birth certificates for minor children, if applicable
    • Emergency contact information
    • Any additional documents or information voluntarily submitted during the application and onboarding process
  • Your information will only be shared with prospective housing providers, landlords, property owners, housing organizations, or referral partners for the purpose of evaluating your eligibility for housing or housing-related services.
  • Safe Haven Rentals does not sell applicant information and will only disclose information necessary to assist with housing placement.
  • Please select one:
  • I voluntarily authorize Safe Haven Rentals to share my application, supporting documentation, identification, income verification, and other information I have submitted with prospective
  • housing providers, landlords, organizations, or referral partners for the purpose of assisting me in
    obtaining housing.
  • I understand this authorization may increase my opportunities for housing placement.
  • I do not authorize Safe Haven Rentals to share my application or supporting documentation with
    other housing providers or referral partners.
  • I understand that declining this authorization may limit my housing opportunities if Safe Haven
    Rentals is unable to accommodate me directly.
  • I understand that authorizing the release of my information does not guarantee housing,
    approval, or placement. Each housing provider, landlord, or organization maintains its own
    screening criteria and approval process.
  • I understand that I may revoke this authorization at any time by submitting a written request to
    Safe Haven Rentals; however, any information already shared before my revocation cannot be
    retrieved.

  • ADDITIONAL INFORMATION

  • 0/0

  • APPLICANT ACKNOWLEDGMENT

  • I certify that the information provided is true and accurate to the best of my knowledge. I
    understand that submission of this application does not guarantee placement. I understand that
    Safe Haven Rentals L.L.C. operates structured shared living programs and all participants must
    comply with program rules and requirements.
  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year

  • IMPORTANT NEXT STEPS*****

  • You have reached the end of this application.
  • To continue the onboarding process, please complete your income & ID verification form as soon as possible. Once this application is submitted, you'll receive a separate email (check your spam/trash) to complete your verification. Applications are reviewed in the order they are received, and space is often limited.
  • Submission of this application alone does not guarantee placement. Applicants who complete both this application and their Income & ID verification will be prioritized for review.
  • After Completing your income verification, you'll be emailed how to schedule your phone consultation to continue our onboarding process.
  • Thank you.
  •  
  • Should be Empty: