IN THE SPIRIT MINISTRY

IN THE SPIRIT MINISTRY
THE PATHWAY HOME ELIGIBILITY VERIFICATION FORM
THIS IS NOT AN APPLICATION

This form is a pre-application screening to determine potential eligibility for the Pathway Home Program. After submitting, you will be notified of eligibility and next steps. Submission does not guarantee acceptance, placement on an approved waitlist, or housing availability.
1 Applicant Information
Full Name and Age

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
2 Household Composition
Household Size
Full names and ages of all household members under 18
Full names and ages of all household members age 18 and older
3 Current Housing Circumstances
What is your current housing situation? (Head of household, living with family/friends, unhoused, other)
Are you currently displaced due to financial hardship, unsafe living conditions, or other urgent circumstances affecting housing stability?
If yes, briefly explain your circumstances.
4 Employment and Household Income
Employment Status
Current Employer
Employer's Address and Phone Number
Job Title
Date Hired

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gross Monthly Employment Income
Other household income sources and monthly amounts
Annual Household Income *
Include income from employment and other sources.