• Eligibility Screening Tool

    Answer the questions to see if you meet the requirements.
  • Thank you for your interest in ART Housing & Social Services. This screening helps determine whether you may be eligible for our supportive housing program. Completing this screening does not guarantee admission.
  • Applicant Information
  • Format: (000) 000-0000.
  • Have you previously applied for this program?
  • Current Housing Situation
  • Where are you currently living?*
  • Are you currently at risk of losing your housing within the next 30 days?*
  • Behavioral Health
  • Do you currently have:*
  • Daily Living
  • Can you safely complete most daily activities independently?*
  • Income
  • What is your primary income source?*
  • Safety
  • Are you currently experiencing any of the following?*
  • Program Expectations
  • Are you willing to follow house rules?*
  • Are you willing to maintain respectful behavior toward staff and other residents?*
  • Are you willing to participate in developing personal goals?*
  • Eligibility Questions
  • Are you at least 18 years old?*
  • Are you seeking supportive housing?*
  • Are you able to live in a shared residential setting?*
  • Have you been diagnosed with a mental health condition?*
  • Are you currently receiving behavioral health services?*
  • Do you require 24-hour nursing or medical supervision?*
  • Are you willing to participate in case management?*
  • Are you willing to comply with all program policies?*
  • Additional Information
  • Electronic Signature
  • Date*
     - -
  • Should be Empty: