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RSA HOMES- Waitlist Application

Thank you for your interest in RSA Homes.
This form is for individuals seeking placement in our shared housing program. Submission places you on our waitlist and does not guarantee immediate availability. Qualified applicants will be contacted as openings become available.

1. Full Legal Name

2. Phone Number

3. Email Address

4. Date of Birth

5. Current City & State

6. When are you looking to move?

A
B
C
D
E
F
G

7. Which type of housing are you seeking?

A
B
C
D

8. Preferred Location (within MN)

9. How long do you anticipate needing housing?

A
B
C
D

10. What lifestyle challenges have impacted your housing stability in the past?

11. What type of living environment helps you succeed and remain stable?
(For example: structured environment, quiet setting, accountability, transportation access, etc.)

12. RSA Homes operates under house guidelines and shared living expectations. Are you willing to comply with house rules and community standards?

A
B

13. Have you previously lived in shared housing?

A
B

If yes:

What worked well and what did not?

14. Employment Status

A
B
C
D
E

15. Monthly Income Range

A
B
C
D

16. Are you able to provide documentation of your last 3 months of income (employment, sponsorship, disability, or other sources)?

A
B
C

17. Upload documentation of your last 3 months of income (employment, sponsorship, disability, or other sources)?

18. Have you maintained on-time rent payments for the past 12 months?

Please explain any recent payment challenges:

19. What are your long-term housing goals?

A
B
C
D

20. Would you be interested in learning about a future housing advancement pathway (such as a contract-for-deed opportunity) if you successfully demonstrate 24 months of consistent on-time payment?

A
B
C

21. What does long-term housing stability look like to you?

22. Are you currently working with a case manager or referral partner?

A
B

If yes:
Case Manager Name & Organization

23. Applicant Acknowledgment