Apply – Faith and Hope Housing

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Personal Information

Fields marked * are required.

Full Name *

Preferred Name

Date of Birth *

Desired Move-In Date

Gender *

SSN — Last 4 DigitsNever enter your full Social Security number here.

Phone *

Email *

Driver’s License / State ID #

State Issued

Emergency Contact

Name *

Relationship *

Phone *

Current Housing Situation

Where are you currently living? *

How long have you been there?

Why are you seeking transitional housing? *

Employment & Income

Current Employment Status *

Employer

Monthly Income

Primary Source of Income

Military Service & Education

Have you served in the military? *

Branch

Years Served

Honorable Discharge?

Highest Level Completed

Health & Current Services

Share only what staff should know to evaluate support needs and safety.

Medical conditions staff should know about

Current medications

Allergies

Are you currently receiving any of these services?

Mental Health Services Substance Recovery Services Case Management None

Criminal Background

Faith and Hope Housing reviews each application individually. A criminal history does not automatically disqualify an applicant.

Have you ever been convicted of a felony? *

If yes, please explain

References

Reference #1 Name

Relationship

Phone

Reference #2 Name

Relationship

Phone

Supporting Documents

Accepted file types: PDF, JPG, JPEG, or PNG. Maximum 8 MB per file.

Photo ID

Income Verification

Referral Document

Program Expectations & Signature

By signing below, I understand that I am applying for transitional housing; providing false information may result in denial or dismissal; I agree to follow house rules and program expectations if accepted; and acceptance is not guaranteed.

Type Your Full Legal Name *Typing your name serves as your electronic signature.

Date *

Take the first step toward stable housing.