Housing Assistance Application

Supporting Documents

PDF icon Homelessness Certification (113 KB)
Date
This can be a phone number, email address, or other method that is the best way to contact you (family member, friend, case worker).
Date of Birth
Are you currently, or were you ever, in foster care?
Housing Situation
Eviction Date
Are you receiving services from another organization that knows your currently living situation?
If so, please ask a staff member to fill out the Homelessness Certification Form and submit it with your application. If not, please continue with the application.
Add additional household member
List all household members living with you
Household Members
List all household members living with you
Name of other household member
Add additional household member
List all household members living with you
Household Members
List all household members living with you
Name of other household member
Add additional household member
List all household members living with you
Household Members
List all household members living with you
Name of other household member
Add additional household member
List all household members living with you
Household Members
List all household members living with you
Name of other household member
Add additional household member
List all household members living with you
Household Members
List all household members living with you
Name of other household member
Income
List income for all household members
$
Add additional income
Income
List income for all household members
$
Add additional income
Income
List income for all household members
$
Add additional income
Income
List income for all household members
$
Add additional income
Income
List income for all household members
$
Do you have pets?
Do you have your own transportation?
Is anyone in your household currently:
This does not negatively affect your eligibility for housing programs.
I solemnly declare under penalty of perjury that the statements made herein are true and correct to the best of my knowledge and belief. I am aware that the information given may need to be confirmed by a Social Worker or Welfare Fraud Investigator and I agree to cooperate as applicable. I am aware that it is unlawful to give false information.
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