Homelessness Prevention Eligibility

Name(Required)

Date of Birth(Required)

Phone

Q1: My total household income is below 50% Area Median Income for my household size (see table below).(Required)

Q2: I have resources or other support networks like family or friends who I can stay with or who can provide other assistance to prevent me from becoming homelessness.(Required)

Q3: If I have received rental assistance through a HUD funded program in the past 3 years, the total length of rental assistance I received was not more than 24 months.(Required)

Q4: I have been notified that I must be out of my current housing or living situation: (select the most accurate option)(Required)

Q5: Do any of the following currently apply to you (select all that apply)(Required)

Have moved because of financial reasons 2 more times in the past 60 days

Currently reside in the home of another person because of financial hardship

Currently reside in a hotel or motel which is not paid for by a charitable organization or government agency

Live in studio apartment/unit with 2 or more other people

Currently exiting jail, a hospital, or other institution with no alternative housing

None of the above

How many adults are in the household?(Required)

Please enter a number from 1 to 99.

How many children are in the household?(Required)

Please enter a number less than or equal to 99.