Housing Request Form

Housing Request Form

Thank you for your interest in Solace Living. We provide safe, supportive transitional housing for adults experiencing homelessness or housing instability. Completing this form is the first step in determining whether our program may be a good fit for your needs. Please note that submitting this form does not guarantee housing placement. A member of our team will review your information and contact you regarding the next steps if additional information is needed.
Full Name

First NameLast Name
Date of Birth

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
Current Housing Status
Where are you currently living?

Other
How long have you been in your current living situation?
Are you currently experiencing homelessness?
Do you currently have any income?
Are you currently working with a case manager or social worker?
If yes, please provide their contact information:
Angent Name, Case Mananger Name, and Contact Number
Referral Reason
What services are the clients seeking? (Check all that apply)

Other
Breifly describe your current situation and what led you to seek housing assistance:
Emergency Contact Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Consent
Should be Empty:

Current Housing Status