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*
YesNo
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*
SingleMarriedDivorcedSeparatedLive In Partner
2345 or more
YesNo
If you have been evicted before, please provide more details below:
YESNO
If you have been convicted of a serious criminal offense, please provide more details below:
YesNo
YesNo
If yes, please specify the pet/s type and breed
YesNo
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.
YesNo
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