Housing application

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I'm referring someone on behalf of an organization

Applicant's full name

Applicant's email

Applicant's phone

Program

Preferred home

Move-in time frame

When does the applicant need to move in?

Time frame

Current housing situation

Currently homelessEviction pendingUnsafe housingTemporary housingLeaving an institution or programOther housing need

Tell us more about the situation

Children joining the household

Add every child who will live in the home. Birth certificates must be PDF, JPG, PNG, or WEBP — up to 10 MB each.

Background disclosure

This information is reviewed individually and does not make an automatic decision.

Do you have criminal charges or convictions to disclose?

Source of income

Select every source of income the applicant has.

Employment / wagesSSI or SSDISocial Security / retirementUnemployment benefitsPublic assistance (TANF, cash aid)Child support / alimonyVeteran benefitsAgency or program fundingFamily supportNo current incomeOther

Total monthly income ($)Employer or income details

Independent-living readiness

Can they manage daily living independently?Can they manage medications independently?Do they have a transportation plan?Can they manage personal finances?Can they follow shared-house rules?

Support needs or accommodationsThe applicant understands that placement requires following the home’s rules and expectations.

Anything we should know

Required documents: proof of income, identification (ID), and any background paperwork

PDF, JPG, PNG, or WEBP — up to 10 MB each.

Add ID, referral letter, income proof…