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Request Appointment
Thank you for contacting Better Life Housing! We are happy to assist you on your journey to finding stable housing. Regardless of where you are currently, Better Life Housing MN is here to assist you in whichever way is necessary.
Please enter your information below and we will contact you as soon as possible! If you are in need, please feel free to call us at (
507) 850-0482
or send and email to betterlifehousing.mn@gmail.com
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Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Please provide a good contact number to be reached at.
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Your answer
Please provide an emergency contact.
Your answer
Date of Birth
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MM
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YYYY
Do you have Medical Assistance?
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Yes
No
I'm not sure
Are you already working with a Housing Stabilization Services Provider?
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Yes
No
I'm not sure
Do you have a valid form of ID
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No
I'm not sure
Do you have a Primary Care doctor? If yes, please provide the doctors office name and number.
Your answer
Do you have a Case Manager (targeted waiver), Social Workers, and/or Care Coordinators.? If so, please provide their name and a contact number.
Your answer
Do you already have a Professional Statement of Need (PSN)
Yes
No
Not sure
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Do you have disability?
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Yes - Documented disability
Yes- Undocumented disability
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Do you currently have stable income?
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Yes - Working a job
Yes - SSI/SSDI/Other
No
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What is your annual income?
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$0-10,000
$10,001-20,000
$20,001+
Do you have any evictions?
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Do you have Section 8 (Current or Voucher)?
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No
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Preferred counties? (Choose all that apply)
Hennepin
Ramsey
Dakota
Washington
Carver
Other:
Do you have any children? (If yes, include how many)
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Other:
Do you have any pets? (If yes, include how many)
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Other:
When viewing apartments, will finding transportation to and from sites be a challenge for you?
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What is your current living situation?
Transitional housing
Not currently housed/living in car
Living with a friend or family member
Women's or men's shelter housing
Other:
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Do you have a criminal history?
Yes
No
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Would you like resources to obtain a checkings and savings account?
Yes
No
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Do you need assistance with building and repairing your credit?
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No
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How did you hear about us?
Website
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Reason you are reaching out (need our services, looking for resources, wanting to partner, etc.)
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