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 West County
- 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

*Even if eligible, clients must be referred to the Rapid Rehousing Program by Coordinated Entry.
Name (First and Last) *
Email *
Phone Number *
Alternate Phone Number
What is your preferred language?
Clear selection
Where are you/your household currently staying? *
Are you currently living in West County? *
Date of Birth *
MM
/
DD
/
YYYY
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.
Enter the address of your last permanent housing location before your current episode of homelessness.
Street Address *
City *
State *
Zip Code *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy