The Unity Council Community Programs - Intake Form
Until further notice, due to limited capacity and changes to our funding, our housing services are only available to Oakland residents who meet certain income requirements. Income requirements vary by service provided. If you are an Oakland resident who is in need of financial support for your rent, and/or assistance with finding and applying to affordable housing, please indicate which services you require and we will reach out to offer services if possible.

Please contact the phone number 510-535-6101 if you need assistance with filling out this form. We will keep this information confidential. Your answers will help us provide you with the best possible services. Thank you.
Full Name: First *
Middle *
Last *
Date of Birth (Month, day, year) *
MM
/
DD
/
YYYY
Street Address *
City *
State *
Please enter abbreviation of your state. Example: CA, NE, WA
Zip Code *
Please check below if you currently do not have an address:
Primary Phone Number *
Please use the format (000)000-0000
Email
Please leave blank if you do not have an email address
What is your mother's maiden name? *
Gender *
Primary Language *
Required
Race/Ethnicity *
Marital status *
Size of family household *
Number
If you have children, what are their ages? *
Required
Personal monthly income *
Family monthly income *
Education *
If some high school, how many years?
If some college, how many years?
Are you currently attending school? *
Work status *
Do you have a Social Security Number? *
Do you have an Individual Taxpayer Identification Number (ITIN)? *
Do you have health coverage? *
What is your monthly rent or mortgage? *
Are you in any of these situations or identify as part of these groups? Check all that apply
Do you currently receive any of the following benefits? *
Required
Do you want to receive The Unity Council’s monthly email newsletter? *
Are you interested in any of our services? *
Services include: Housing, Financial, Youth and Adult Career, Senior and more
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