Safe To Be - Resident Application
*We are taking applications; however, we do not currently have a home available. Your application will be considered and reviewed when we have an opening. If you are in an emergency situation, please indicate on the form. 

Thank you for your interest in Safe To Be! This is the first step in the application process. In addition to a completed application, you must read, sign, and agree to the Covenants. You must agree to a credit check, police background check, and the final step is an in-person interview. 
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Email *
Are you in a dire, life-threatening, emergency?
We may have temporary options available, if needed.
 *
We believe that love is love, trans people belong, Black lives matter, women's rights are human rights, no human is illegal, science is real, news isn't fake, health care is a human right, and kindness is everything. *
Safe To Be partners with ECHO Village.
All Safe To Be residents must abide by and follow ECHO Village Covenants.
ECHO Village Covenants
1. Be an active community member by interacting with and helping neighbors in every way possible, using the gifts and graces each individual brings.
2. There will be no illegal drug use, and alcohol only in moderation. Smoking is allowed outside only. 
3. Everyone will keep their unit clean and contribute to the upkeep of the entire village. 
4. Respect yourself and your neighbors. Behavior towards each other will be conducted in a peaceful manner, without violence (verbal or physical).
5. Stealing is a breach of trust. You will respect the property of others. 
6. Observe the quiet times as posted in order to keep the peace and welfare of the village.
7. Participate in mentoring program as able and needed (teacher or student). 
8. Take prescribed medication that is critical to health and behavior. 
9. Pay your rent and utilities on time. 
10. Long term guests (>2 weeks) must be approved by committee, and abide by covenants. 
11. Pets will be limited to two per household. Respecting your neighbors, pets will behave in a peaceful calm manner and owners will clean up after their pets. 
12. Respect the environment and participate in recycling for the village. 
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I agree to have a background check performed. *
Refusal to agree may result in immediate decline of application.
I agree to have a credit check performed. *
Refusal to agree may result in immediate decline of application.
Fair Housing Disclosure
The Fair Housing Act of 1968 as amended by the Fair Housing Act Amendments of 1988, prohibits discrimination in housing based on race, color, sex (including gender identity), sexual orientation, national origin, religion, handicap, or familial status. Except as permitted by the Housing for Older Persons Act of 1955, we are committed to complying with the letter and spirit of the laws which administers compliance with the fair housing laws in the United States Department of Housing and Urban Development. 
Identifying Information
Legal First Name *
Legal Middle Initial
Legal Last Name *
Name/Preferred Name/Nickname (if different from above)
Current Address (if none, describe where you live) *
City *
State *
Zip *
Zip of Last Address
Email *
This is the email we will correspond with you with; re-enter the same email from above if it is the same email address.
Phone where you can be reached at (ex. xxx-xxx-xxxx) *
Preferred method of communication: *
Last 4 of SSN or Driver's License #
Pronouns *
Required
My connection to the community is... (check all that apply):
Race
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Ethnicity
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Applicant's primary language *
Secondary language (if applicable)
Do you have reliable transportation? *
Vehicle Info: Year, Make, Model, Color of Vehicle, & State + Tag Information (if applicable)
IMPORTANT TRANSPORTATION INFORMATION
Ride share services (like Uber & Lyft) are extremely limited, however, a trolley service is available around town and a trolley stop is located right outside of the village.
HOUSING INFORMATION
Do you have pets? If so, how many: *
Note: Pets are allowed. Limited to two (2) pets. Indoor cats only. Dogs are to be leashed at all times when outside. Proof of up to date shots required for all pets are to be kept on file.
If you need assistance getting up to date shots, please let us know. 
How many occupants will be in the home? *
Number of bedrooms required *
Will you need housing assistance such as HUD? *
Please enter family members that live with and will be coming with the applicant (name, DOB, & relationship to applicant). If none, type 'N/A'.
 *
*If family member is over 18, they will have to submit their own application.
If you are bringing someone under the age of 18, are you legally entitled to have the child with you and/or move the child out of state (to Arkansas)?
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Are you at risk of homelessness? *
If yes, please describe circumstances.
Length of homelessness this episode (if applicable)
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Where have you slept for the last thirty (30) days? Check all that apply.
What are your long term thoughts and plans to get back on your feet?
What steps have you taken to get back on your feet? What resources have you reached out to for assistance?
This could include friends, family, shelters, etc.
Have you ever been evicted? *
Reason for leaving last housing situation
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Please list housing history for the last five (5) years including:  *
- Location
- Approximate dates
- Lease holder or relationship to primary tenant
- Reason(s) for leaving
Please identify any contributing factors to housing instability.
PERSONAL HEALTH INFORMATION
Do you require physical housing adjustments to accomodate you?  *
If yes, please explain...
Do you currently take medications for a health issue that are essential to your well-being? *
SOCIAL
Describe your support system and social network.
Please list the applicant's recreational activities and/or interests.
VOCATION & EDUCATION HISTORY
Does applicant have a source of income?  *
Is the applicant currently employed either part time or full time? If yes, where is the applicant employed? If not employed, type 'N/A'. *
Job title and responsibilities? (If applicable)
Describe applicant's work experience or history going back three (3) years.
LEGAL INFORMATION / HISTORY
A criminal history does not necessarily mean automatic rejection. It will be reviewed on a case-by-case basis. Failure to disclose may result in termination of assistance.
Have you ever been convicted of a crime? If yes, please list. If none, type 'N/A'. *
EMERGENCY CONTACT INFORMATION
Emergency Contact Name (First & Last): *
Emergency Contact Telephone #: *
Emergency Contact E-Mail: *
Emergency Contact Address:
RELEASES, RULES & REGULATIONS, ETC.
Rules & Regulations
https://forms.gle/qNkQVuEmYiwya4neA
I have read, understand, and I agree to the Rules & Regulations. *
List three (3) references with their contact information and relationship to you. 
Be sure that they are aware that a representative from Safe To Be may be reaching out to them.
When do you wish to begin your stay? *
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How long do you intend to stay? (*Max 1 year)
Why do you want to live in our home? 
If you were to occupy the home, where do you see yourself in 6 months?
If you were to occupy the home, where do you see yourself in 1 year?
If you were to occupy the home, where do you see yourself in 3 years?
What gifts and talents can you bring to this community? 
E-Signature: type your full legal name *
I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. 
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