Waiting List Application

BROWARD HOUSING SOLUTIONS®

Waiting List Application

Broward Housing Solutions® mission is to provide safe, supportive, and permanent housing to clients
with low income and severe and persistent mental illness.

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Initial Screening Questions

1. Has this client previously lived at/been a resident of Broward Housing Solutions (BHS)?
2. Does this candidate demonstrate the ability to live independently?
3. Does this client have a severe and persistent mental illness (SPMI)?
4. Is the client currently homeless?
5. Has the client experienced chronic homelessness?

Applicant Information

Demographics

Name

Sources of Income (Please Fill in all that apply, if unknown please enter 0)

Frequency of income:

History

Has the client ever signed a lease agreement? (Please Check One)
Has the client ever been evicted?
Has client ever been arrested (Please Check One)
Was the client ever convicted of a misdemeanor or felony?

Preference

Veteran (Please Check One)
Disabled Veteran (Please Check One)

Referring Agency

Applicant Household Member Information

Name
Supervisor Name
Please note:

All adults 18 - 26 must have income or enrolled in school full-time. Felony charges such as violent crimes, fraud charges, drug trafficking or registration on the sex offender registry within the last 7 years will not be considered. All clients must have mental health case management with an approved agency. Clients deemed capable of living independently must follow their mental health case management plan, manage finances, maintain sanitary housing, and adhere to the rules set by the landlord. Per the Fair Housing Act, Florida Law Prohibits Discrimination on the basis of race, color, national origin, religion, sex, familial status (including children under the age of 18 living with parents or legal custodians, pregnant women, and people seeking custody of children under the age of 18,) and disability. Additionally, Broward County prohibits discrimination in housing based on sexual orientation, age, and marital status.


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