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RL Homes Pre-Application Form
RL Homes is currently accepting pre-applications for their affordable housing. Please fill out this form completely and someone will follow- up with.
*Submitting this form does not guarantee your placement.*
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* Indicates required question
Email
*
Your email
Who are you applying for?
*
Choose
Myself
Family Member
Client (I am a Case/ Social Worker or Sponsor)
Client's Full Name
*
Your answer
Client's Phone Number
*
Your answer
Client's Date of Birth
*
Your answer
Client's Gender
*
Your answer
Bedroom of interest
*
Private Bedroom
Shared Bedroom
No preference
When will you or your client like to move in?
*
MM
/
DD
/
YYYY
Does the client have a violent criminal record? If yes, explain
*
Your answer
Does the client have any criminal sexual conduct offenses? If yes, explain
*
Your answer
Is the client drug free and sober?
*
Your answer
Which best describes the client's monthly income:
*
$650 or less
$700-$900
$950- $1,000
$1,000+
How will you or your client pay for housing?
*
SSI
SSDI
Agency Funding
Private Pay (job, unemployment, family member, etc)
How long does the client expect to live at RL Homes?
*
1 month
2-4 months
5-7 months
8 months+
Is there anything else that you would like us to know about yourself or client?
*
Your answer
If you are filing this form out on behalf of a client, please leave your name, number, email and organziation
*
Your answer
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