Utah County Housing First Fund Application
This application is bound by UCHFF policies and procedures as approved by the CoC. You must have first completed the UCHFF online training before submitting this form. To complete training, please go to this link on the MCoC website: __________. Remember that you can apply on behalf of this client multiple times if denied. The client cannot be funded more than once in twelve months, with the exception of being funded for miscellaneous expenses that total less than $100 (e.g, application fee). You must be able to fully answer all required questions in order to be accepted for review.
Applicant Name (case management supervisor) *
Your answer
Case manager name (working directly with client) *
Your answer
Name of client (first, middle, and last) *
Your answer
Client's date of birth *
MM
/
DD
/
YYYY
Is this individual chronically homeless?
Is this individual a veteran?
Has the client already found a unit for rental? *
By what date is funding expected (if different from above)
MM
/
DD
If yes, when is the anticipated move-in date? *
MM
/
DD
Did the case manager need to negotiate with the landlord on behalf of this client? *
Has the landlord already run a criminal background check on the client? *
Is there any criminal activity in this client’s history that would prevent this landlord from leasing the unit? (EX: No misdemeanor in the last 5 years, no felonies in the last 10 years)? *
Is the landlord already in agreement to house this client? *
If not or in process, explain the situation below:
Your answer
Client's monthly income *
All forms of income, including SSI or SSDI
Your answer
How will the client be paying for monthly rent? *
Check all that apply
Required
Could any of the subsidies listed above assist with initial housing costs (security deposit, first/last months’ rent, etc.) *
If yes, how are you using these, or why aren't you using these, to cover the client's initial housing costs?
Your answer
How much is the security deposit? *
Your answer
How much will monthly rent be? *
Your answer
Is it FMR? *
Zero: $500, One: $639, Two: $763,Three: $1,103, Four: $1351
How much would the client desire to contribute to a security deposit, if able (no more than 30% of total)
Optional
Your answer
Which funding options have you already explored for the client? Why is this fund the only option for the client? *
Your answer
Client needs
Check all that apply
How much does the landlord want for a damage guarantee deposit (if applicable)?
This can only add up to the total amount of another security deposit.
Your answer
If the landlord desires the damages guarantee deposit, have you scheduled an appointment for or have you already conducted the Landlord Pillar program interview? *
Additional financial need for entering housing (application fee, pet deposit fee, ID funds, etc,):
Please list each item and the amount. Remember that Community Action has funds for IDs, applications, and other forms of documentation. Check there first!)
Your answer
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