Rapid Re-Housing Application
WCCS Rapid Re-Housing program assists families and individuals in becoming stably housed and self-sufficient through short-term financial assistance and supportive services.

In order to meet the basic eligibility criteria, you must be:
- Currently residing in the lower Russian River area (Forestville to Jenner)
- Enrolled in Coordinated Entry
- Literally homeless at the time of intake OR within 14 days or less of becoming homeless
- Able to financially sustain housing situation once assistance is completed
- Willing to engage in regular case management

Name (First and Last) *
Your answer
Email *
Your answer
Phone Number *
Your answer
Alternate Phone Number
Your answer
What is your preferred language?
Where are you/your household currently staying? *
Are you currently living in the lower Russian River area (Forestville to Jenner)? *
Date of Birth *
Have you ever served in the United States Military? *
Number of people in your household (including yourself) *
List the names and dates of birth for all additional household members.
Your answer
Enter the address of your last permanent housing location before your current episode of homelessness.
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service