Low Income Housing Institute

 True Hope Village Intake Form

Low Income Housing Institute

Date: ___________________________________ Time: __________________________

First Name: _____________________________________________________________

Middle Name: ___________________________________________________________

Last Name: _____________________________________________________________

State: __________________________________________________________________

Contact Number: _________________________________________________________

Number of Children (if applicable): _______________________________________

Name & Age of Children:

  1. _________________________________________     Age: ______________
  2. _________________________________________     Age: ______________

CODE OF CONDUCT

We, the people of the Low Income Housing Institute, in order to keep a more harmonious community, ask that you observe the following Code of Conduct:

IF THESE RULES ARE NOT RESPECTED AND ENFORCED, DISCIPLINARY ACTION WILL BE TAKEN, AND MAY LEAD TO BEING BARRED FROM THE VILLAGE.

Other Site Rules:

  1. Residents must use the main gate for entry and exit.
  2. Be courteous to our neighbors.  No loitering around the village and surrounding area.
  3. Use the designated restrooms.
  4. All possessions and personal belongings must stay inside your designated tiny house unit.
  5. All recycling, trash and compostable/food are to be separated and properly disposed.
  6. Pets must follow LIHI Pet Policies.  All pets and service animals must be on leashes outside the tiny houses.
  7. Tiny houses must be maintained in good order, and any repair problems should be reported promptly. Pests and bed bug infestation must be reported immediately.
  8. There will be a weekly inspection during the first month of tenancy followed by a monthly inspection. There will be a general 48-hour notice given to the residents prior to the inspection.

Case Management: LIHI is providing Case Management services to True Hope Village. The LIHI Case Manager will do Homeless Management Information System (HMIS) surveying and data entry – in an informed-consent fashion. Within seven days of intake into True Hope Village, new participants are required to check in with the LIHI Case Manager and complete the HMIS Informed Consent and Demographics forms. Case Management is required at True Hope Village. HMIS data collection is a requirement of the Seattle Human Services Department.

I/we by my/our signature(s) below, acknowledge that I/we have read and understand the above agreement and agree to be bound by them.

I acknowledge that a copy of this document was provided to me.

Participant Signature: ________________________________        Date: __________________

Participant Signature: ________________________________        Date: __________________

LIHI Staff Signature: _________________________________        Date: __________________

Special Projects Manager Signature: ___________________     Date: __________________

 | Page