In Home Stabilization Program

In Home Stabilization Program

LANDLORD FORM ONLY
LANDLORDS ONLY — PLEASE READ

This form is for landlords/property owners only to refer a tenant to our In-Home Housing Stabilization (IHS) Program.

Tenants should NOT complete this form. If a tenant submits this form, the request will be denied.

Please note: IHS is not a financial assistance program and does not provide rental payments or other direct financial assistance. The program provides case management and housing stabilization support to help eligible households maintain stable housing.
Full name of Landlord/Property Manager

First NameLast Name
Landlord/Property Manager Email
example@example.com
Direct Landlord/Property Manager Phone
Please enter a valid phone number.Format: (000) 000-0000.
Landlord/Property Manager Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tenant Name

First NameLast Name
Tenant Email
example@example.com
Tenant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Tenant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Rental Location
Monthly Rent
Number of children under the age of 18 on the lease
Reason for Referral
Why do you believe this family would be a good candidate for stabilization?
Are you willing forestall eviction to allow Family Promise to work with this family to address their housing issues?
Do you have permission from the lease holder to refer him or her to Family Promise HCR for program pre-screening?
Should be Empty: