• PATHWAY HOUSING INTAKE FORM

    Housing Pathways Statement: This assessment is designed to connect individuals and households—regardless of their current qualification status or credit history—with diverse, sustainable pathways to long-term housing stability. Our initiative goes beyond traditional placement by offering flexible living arrangements tailored to your goals, including shared co-ownership and roommate co-living models, traditional leasing in single-family homes, condominiums, or townhouses, and collaborative development opportunities to build new housing solutions alongside us. By evaluating your background, financial resources, and preferences holistically, our objective is to bridge systemic barriers and empower every participant with viable, dignified options for permanent housing and community integration.
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  • SECTION 1: APPLICANT / TENANT INFORMATION

  • Format: (000) 000-0000.
  • Desired Move-In Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • SECTION 2: VOUCHER & PROGRAM DETAILS

    Landlord Packet: Landlord completes ownership/W-9 details in the RTA packet and returns it to the case manager
  • Do you have a vocher?*
  • Housing Program Type
  • Voucher Expiration Date:
     - -
    2 digit month, 2 digit day, 4 digit year

  • SECTION 3: HOUSING SELECTION

  • Are you interested in Renting or Purchasing a House?*

  • RENTAL HOUSING LOCATION PREFERENCE

  • Please select up to 5 preferred locations
  • Housing Structure Preference*
  • Bedroom Selection*

  • SECTION 4: HOUSING HISTORY & STABILITY

  • Have you ever been through a formal eviction process or had a legal housing judgment filed against you?*

  • SECTION 5: RENTAL & FINANCIAL BACKGROUND

  • Do you currently have any unpaid balances, utility collections, or past-due amounts owed to previous landlords or utility companies?*
  • Do you anticipate any challenges with a credit or background check (such as low credit, lack of rental history, or past justice-system involvement)?*
  • What current sources of income or financial support does your household receive? (Select all that apply)*
  • Approximately what is your total gross (pre-tax) monthly income from all sources combined?*
  • Do you currently hold any housing vouchers or certificates? (e.g., Section 8 / Housing Choice Voucher, VASH, Mainstream Voucher, Rapid Re-Housing assistance)*
  • If your current income does not fully cover standard market rent, do you have access to a co-signer, guarantor, family support, or a subsidy program that can help bridge the gap?*
  • Do you have any current or recent bankruptcies?

  • SECTION 6: Co-Housing & Roommate Match Preferences

  • Are you interested in co-housing?*
  • As part of our commitment to a safe, secure, and reliable living environment, all prospective roommates are required to pass a background check prior to lease signing or move-in. Do you consent to undergoing a background check if selected to move forward?*
  • Do you have any preferences regarding the makeup of your future household? (Select all that apply)
  • Are you open to households with working professionals, students, or individuals transitioning out of housing programs? (Select all that apply)
  • Which best describes your typical daily schedule and routine? (select all that apply)
  • Question: How would you describe your standard for cleanliness and shared spaces?
  • How do you prefer to handle shared household chores (e.g., kitchen cleaning, taking out trash, common areas)?
  • Which of the following best describes the atmosphere you prefer in your home?
  • How do you feel about guests visiting the home?
  • What are your preferences or requirements regarding smoking or substance use in shared living spaces?
  • Do you have or are you comfortable living with pets?

  • SECTION 8: APPLICANT CERTIFICATION, ACKNOWLEDGMENT, & PRIVACY CONSENT

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: