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VETERAN HOUSING APPLICATION

Thank you for your service, and for taking this step toward stable housing. This application helps us understand your situation and determine if Veteran Housing is the right fit for you right now. All information is kept confidential. Our team will respond within 3–5 business days.

Section 1 — Applicant Information

Full legal name

Date of birth

Phone number

Email address

Current mailing address

Emergency contact name, relationship, and phone number

Section 2 — Voluntary Demographic Information

This section is voluntary and used only for internal reporting and grant/funder compliance. It does not affect your eligibility or application in any way.

Gender

Woman

Man

Non-binary

Prefer to self-describe

Prefer not to answer

Race

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Pacific Islander

White

More than one race

Prefer not to answer

Ethnicity

Hispanic or Latino

Not Hispanic or Latino

Prefer not to answer

Do you identify as having a disability?

Yes

Prefer not to answer

Section 3 — Military Service & Eligibility

Branch of service and dates served

Discharge status

Honorable

General

Other-Than-Honorable

Dishonorable

Still Serving (explain if needed)

Are you currently enrolled in VA healthcare or benefits?

Yes

Do you have a service-connected disability rating?

Are you currently working with a VA case manager or veterans service organization?

Section 4 — Current Situation & Finances

What is your current living situation?

Do you have a current source of income?

Employment

VA disability compensation

Pension

None

How do you intend to fund your housing fees?

VA benefits

Personal income or employment

Pension or disability compensation

Family support

Uncertain (please explain)

Other

Do you have any pending legal issues we should be aware of?

Do you have any physical or mental health needs that would affect your housing placement or accommodations?

Section 5 — Agreement & Consent

Please review and check the following:

Terms of Agreement

I understand this is structured housing and agree to abide by house rules.

I consent to a standard background and safety screening as a condition of consideration.

I understand this application does not guarantee placement and is subject to availability.

Signature

Please sign here

VETERAN HOUSING APPLICATION

Section 1 — Applicant Information

Full legal name

Date of birth

Phone number

Email address

Current mailing address

Emergency contact name, relationship, and phone number

Section 2 — Voluntary Demographic Information

Gender

Race

Ethnicity

Do you identify as having a disability?

Section 3 — Military Service & Eligibility

Branch of service and dates served

Discharge status

Are you currently enrolled in VA healthcare or benefits?

Do you have a service-connected disability rating?

Are you currently working with a VA case manager or veterans service organization?

Section 4 — Current Situation & Finances

What is your current living situation?

Do you have a current source of income?

How do you intend to fund your housing fees?

Do you have any pending legal issues we should be aware of?

Do you have any physical or mental health needs that would affect your housing placement or accommodations?

Section 5 — Agreement & Consent

Terms of Agreement

Signature

Date of signing