Shared Housing Application

Thank you for your interest in becoming a resident at Pyramid House! Our application process is designed to ensure a safe, supportive, and empowering living environment for all residents. We look forward to learning more about you and how we can help you on your journey towards a better life.

Please review the House Rules prior to submitting your application.

First Name:

* Required

Last Name:

* Required

Email Address:

* Required

Cell Phone:

* Required

Date of Birth: * Required

Current Address (If no, please tell us where you sleep)

* Required

Current Address Suite/Apt #:

Current Address City:

* Required

Current Address State:

* Required

Current Address Zip:

* Required

Desired Move-in Date: * Required

Social Security Number:

* Required

Monthly Income:

* Required

Source of Income:

* Required

Name & Contact Info for any organizations or case manager you may be working with:

Are you a citien of the United States:

* Required

If no, are you authorized to work in the US?

* Required

Do you receive a housing voucher or subsidy?

* Required

If yes, what type or source?

Have you ever been convicted of a felony?

* Required

If yes, list charge(s) and County:

Please explain any pending charges:

Education

Highest grade or level of education completed:

* Required

Name of School:

* Required

Are you currently enrolled in an education program?

* Required

If yes, what is the program?

Program Address:

Program Phone Number:

Emergency Contact Info

Emergency Contact Info:

House Rules & Requirements

House Rules & Requirements:

* Required

Do you agree to abide by all House Rules & Requirements?

* Required

If there are any rules or requirements that you are unable to abide by, please indicate here and explain why:

Military Service

Branch of Service:

Dates of Service:

Rank at Discharge:

Type of Discharge:

If other than honorable, please explain:

I certify that my answers are true and complete to the best of my knowledge. If this application leads to housing, I understand that false or misleading information in my application or interview may result in my release.

* Required

Disclaimer & Agreement Date: * Required

Please leave this checkbox blank