Bridge to Stability Foundation Inc. Housing Pre-Application
Thank you for your interest in Bridge to Stability Foundation Inc. We are preparing to launch our transitional housing program and are currently accepting housing pre-applications from individuals seeking safe, stable housing. Completing this pre-application helps us better understand your housing needs and allows us to contact you as housing opportunities become available. Please note: Submitting this pre-application does not guarantee housing or placement. All applicants will be reviewed based on eligibility, program requirements, and housing availability.
Are you applying for yourself or on behalf of someone else?
*
I am applying for myself.
I am applying on behalf of someone else.
Applicant Information
First Name
*
Last Name
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is there another way to reach you if your phone is unavailable or disconnected?
*
Yes
No
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred Contact Method
*
Please Select
Phone
Text
Email
Current Housing Situation
Current living situation
*
Experiencing homelessness
Staying with family or friends
Shelter
Hotel/Motel
Renting
Other
City
*
State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Which population best describes your housing need?
*
Individual Adult
Family with Children
Veteran
Young Adult (18–24)
Returning Citizen (Reentry)
Person with a Disability
Senior (55+)
Other
When do you need housing?
*
Immediately
Within 30 Days
Within 60 Days
Within 90 Days
How many people will need housing?
*
Just Me
Me and 1 Child
Me and 2 Children
Me and 3 or More Children
Couple
Family
Other
Income Information
Do you currently receive income?
*
Yes
No
Income sources
Employment
SSI
SSDI
VA Benefits
TANF
Retirement
Other (please specify)
Other
Support Services
Do you currently have a case manager?
*
Yes
No
Agency Name
*
Case Manager Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Contact Information
Please provide someone we may contact only if we are unable to reach you regarding your housing pre-application.
Relationship to You
Please Select
Parent
Sibling
Child
Friend
Relative
Spouse/Partner
Case Manager
Other
Alternate Contact Name
First Name
Last Name
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Email Address
example@example.com
Consent to Contact Alternate Contact
I authorize Bridge to Stability Foundation Inc. to contact the person listed above only if you are unable to reach me regarding my housing pre-application.
Applicant Certification and Agreement
Certification
*
I certify that the information I have provided is true and accurate to the best of my knowledge.
I understand that this is a housing pre-application and does not guarantee housing or placement.
Electronic Signature
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Privacy Notice: The information you provide will be used only to review your housing pre-application and communicate with you about available housing opportunities. Bridge to Stability Foundation Inc. will maintain your information in accordance with applicable privacy and confidentiality practices.
Submit Housing Pre-Application
Submit Housing Pre-Application
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