Request for Services Form (Housing program & HUD referrals)
Please complete this form to be considered for our program or to receive resources for HUD services and referrals. Please note: THIS IS NOT AN APPLICATION FOR HOUSING. Please complete all required information for a faster response and assistance. 
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Email *
Full name of person needing assistance *
Name and relation of the person completing this form? If it is yourself, please list your name again.  *
Contact E-Mail address *
Current or last known address (street, city and zip code) *
If the person if currently incarcerated, please state the jail or prison they are at
Contact phone number *
What number should we contact for placement
Date of Birth? (person needing service) *
MM
/
DD
/
YYYY
What is your household income level?  *
Type N/A if this is unknown
Required
Please select all of the services you are requesting. *
Required
Have you been evicted or currently homeless?  *
What is your current housing status?
Have you already spoken with a staff member of The Faith Project regarding housing, referrals and services ? *
Program housing request (NOT HUD CLIENTS): Were you sent a housing application and paid the application fee? *
Type N/A if this is unknown
Program housing request: If you have completed and housing application? How and when was the application fee paid?
Contact information of attorney, counselor or probation/parole officer. *
Type N/A if this is unknown
Is the client employable and willing to begin working within 24-48hours of intake? *
Comments/Additional information you want us to consider *
There are additional forms that would follow to complete the intake process and to receive referrals for low-income housing or to become a client at The Faith Project. Do you agree to complete this process and receive these references from this organization?  *
Required
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