Online Referral Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The Burlington Housing Authority's (BHA) Housing Retention Team provides rapid intervention for households at-risk of becoming homeless. We focus our services on very-low income vulnerable households in Chittenden County.

**Due to current referral volume, we are implementing a waitlist. Please bear with us as we work to deliver services to Burlington and Chittenden County. You will receive follow-up from our team within 5-7 business days.**

Referral is for: *

Housing Retention for Renter

Housing Retention for Homeless Household

Other:

Is the household living in one of the following: *

BHA Owned or Managed Property with BHA subsidy (Section 8 Voucher)

BHA Owned or Managed Property without BHA Subsidy (Section 8 Voucher)

Champlain Housing Trust Property with BHA subsidy

Champlain Housing Trust Property without BHA subsidy

Cathedral Square Property with BHA subsidy

Cathedral Square Property without BHA subsidy

COTS Property

Unit with private landlord with BHA subsidy (Section 8 Voucher)

Other:

Clear form

Never submit passwords through Google Forms.

This form was created inside of Burlington Housing Authority. Report Abuse

Forms