PSH Housing Interest Form

PSH Housing Interest Form
Property Information
Are you a single parent currently enrolled in a college degree program and seeking affordable housing? Pittsburgh Scholar House is here to support you. We invite you to express your interest in Pittsburgh Scholar House's Residential Program, designed specifically for students like you who are balancing higher education with parenthood.
Pre-Eligibility Questions
Are you currently enrolled in a college degree program?
What University or College do you attend?
Type of Degree You are Pursuing
Will children under the age of 18 live in the home with you?
Background Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
How many other people will be living in the unit with you?
Person 1 Name
Person 1 Age
Person 1 Sex
Your Relationship to Person 1
Person 2 Name
Person 2 Age
Person 2 Sex
Your Relationship to Person 2
Person 3 Name
Person 3 Age
Person 3 Sex
Your Relationship to Person 3
Person 4 Name
Person 4 Age
Person 4 Sex
Your Relationship to Person 4
Person 5 Name
Person 5 Age
Person 5 Sex
Your Relationship to Person 5
Marital Status
What is the minimum number of bedrooms you need?
Do you have a history of being evicted before?
If you have been evicted before, please provide more details below:
Have you ever been convicted of a serious criminal offense?
If you have been convicted of a serious criminal offense, please provide more details below:
Is anyone in the home a smoker?
Do you have pets?
If yes, please specify the pet/s type and breed
Are you currently experiencing homelessness?
Do you have a voucher from Housing Authority City of Pittsburgh?
What is your voucher number?
Enter only if known. If unsure, you can leave this field blank.
Are you currently in a lease?
When does your lease expire?

MonthDayYear
Date
If offered a unit, when would you be available to move in?

MonthDayYear
Date
Current Income Details
Annual Income
Number of People in Household
Agreement
Name of Applicant

First NameLast Name
Applicant Signature
Date Signed

MonthDayYear
Date
Should be Empty:

PSH Housing Interest Form

Property Information

Pre-Eligibility Questions

Background Information

Current Income Details

Agreement