Submit an Application Step 1 of 5 20% NAME(Required) READ BEFORE FILLING OUT APPLICATION(Required)I understand and agree that by submitting this application, this is not a guarantee of tenancy. I also understand that this application means that I am on the wait list for tenancy at Anchor House. By placing my initials below, I am giving my acknowledgment of the above facts. Personal InfomationAre you homeless or about to be homeless? Our mission includes serving all homeless individuals regardless of gender.(Required)CHOOSE ONE Homeless About to be homeless If you chose homeless, what best describes where you slept for the last 7 days?(Required)CHOOSE ONE Tent or storage locker Vehicle Couching Literally without any shelter at all Are you from Warren County? If not, do you have family connections in the county or work here now? (select all that apply)(Required) Warren County resident Family in Warren County Employment in Warren County Not now or ever been a Warren County resident Date of Birth(Required) Month Day Year Driver's Licence/State ID Number Phone(Required)Email (Please make sure this is valid)(Required) Last Permanent Address Street Address City State / Province / Region ZIP / Postal Code Other Occupants?(Required) Yes No NumberPlease enter a number less than or equal to 2.Relationship Pets? Yes No NumberDo you have a vehicle?CarVanTruckNoneEver Been Convicted of a Crime?(Required) Yes No If convicted of a felony involving drugs, did you complete a drug recovery progam? If yes, what year? List crime below (include year and class) Ever Been Evicted by a Court?(Required) Yes No If yes, what year and do you owe any money to the landlord? Housing Voucher? Yes No Veteran? Yes No Current EmploymentCompany Occupation/Title Company Address Street Address City State / Province / Region ZIP / Postal Code How long employed? Gross monthly Income If not currently employed, what is your source of income?(Required) How much monthly?(Required) Do you have any of the following Loan Payment(s) Alimony Child Support Payments Student Loan(s) Out of pocket Medical Expenses Other______________________________________________ CURRENT/PREVIOUS LANDLORDS:(Please list at least 2)Name of Landlord/Property Manager First Last PhoneName First Last Name of Landlord/Property Manager First Last Phone PERSONAL REFERENCES(PLEASE LIST AT LEAST ONE EMERGENCY CONTACT)Name(Required) First Last Relationship Phone(Required)Name First Last Relationship Email PhoneName First Last Relationship Email Phone Would you need and accept an onsite Compass worker to help you with your goals?(Required) Yes No I'm have signed an agreement to meet with a Compass counselor Anchor House thrives on its strength in community. If you were to be accepted, how active would you be in our community?(Required) Very active Active Not Active Explain your above answer here. CONSENT AND ACKNOWLEDGMENTI hereby certify that I am at least 18 years of age. Applicant represents that all information given on this application is true and correct. Applicant hereby authorizes verification of all references and facts, including but not limited to employers, and personal references. Applicant hereby authorizes owner/agent to obtain any and all Unlawful Detainer, Credit Reports, Tele checks, and/or Criminal Background Reports. Applicant agrees to furnish additional credit and/or personal references upon request. Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing which may result in denial of tenancy. Applicant hereby waives any claim and releases from liability any person providing or obtaining said verification or additional information. By signing this application, you grant Anchor House Owners/Management permission to communicate with all the contacts if we cannot locate you. If you abandon the tenancy for any reason, then you grant us permission to allow your contact(s) listed above to remove all contents of the dwelling on your behalf.By typing your full name below, you are stating that you have read the above statment and that you consent to submitting this application.(Required)
