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Request Housing Support

Housing Support • Waiting List • Intake Form

Housing Assistance Request

Use this form to request housing support and join our waiting list. We review requests based on urgency, eligibility, and available resources. Submitting this form does not guarantee housing assistance.

Waiting list intake

Emergency referrals (if available)

Rental/utility support (limited)

Case-by-case review

Important

  • This is a waiting list intake form.
  • Approval is not guaranteed.
  • We may provide referrals if assistance is unavailable.

If you are in immediate danger, call 911 or local emergency services.

    Applicant Information





    Household Information





    Current Housing Situation





    Type of Housing Help Requested

    Support Options (Select all that apply)

    All support depends on funding, eligibility, and availability.

    Urgency

    Emergency requests may be referred to local shelters or services.

    Income & Employment (High-Level)



    Your Situation (Brief Explanation)



    Do not include SSN, bank info, passwords, or immigration status.

    Waiting List Notice (Required)

    This is a waiting list intake. Submitting this form does not guarantee approval or housing assistance. Requests are reviewed based on urgency, eligibility, available funding, and program capacity. If we cannot assist directly, we may provide referrals to other local resources.

    I understand this is a waiting list and assistance is not guaranteed.

    Privacy


    Your information is used only to review your request and coordinate possible support. We do not sell personal information.



    Emergency Notice: If you are in immediate danger or need urgent shelter tonight, contact your local emergency services or a nearby shelter hotline. This form is for waiting list intake and does not provide immediate emergency shelter.

    What This Form Is

    An intake form to join our housing assistance waiting list. We may contact you for follow-up, verification, or referrals.

    Tip: Include key dates (eviction/shutoff) and the type of help you need most.

    What We May Support

    Based on availability:

    • Housing referrals
    • navigation Navigation/case management
    • Limited rental or utility support
    • Limited repairs assistance

    Emergency Resources

    If you are unsafe or need shelter immediately, call 911 or contact local emergency housing services in your area.