Waiting List Application

Initial Screening Questions

Applicant Information

Demographics

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

History

Preference

Referring Agency

Applicant Household Member Information

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.