Eden, Inc. Housing Application Form Page 2
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7Third Project Housing Application
Describe Your Current Housing Situation (i.e. Homeless, Hospital, Group Home)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Have You Ever Maintained Your Own Housing Unit?
Yes_____ No_____
Have You Resided In Eden Owned Housing?
Yes_____ No_____
If Yes, Why Did You Leave? _______________________________________________
________________________________________________________________________
If you are homeless – please answer the following 3 questions:
Are you: ____ In a shelter? ____ On the streets? ____ In transitional housing?
Have you been continuously homeless (staying in shelter/on streets) for one year or
more?
______ Yes
______ No
Have you had at least four episodes of homelessness (staying in shelter/on streets) in the
past three years?
______ Yes
______ No
List Previous Housing – Brief History (DO NOT Include Current Housing)
Address
Type
Dates
1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________
List Landlord Information – Current and/or Previous 2
Name
Address
Phone
1. ______________________________________________________________________
2. ______________________________________________________________________
Was Any Previous Dwelling Damaged By Fire?
Yes ____ No ____
Have You Ever Been Evicted?
Yes ____ No ____
Have You Ever Been Convicted Of A Felony?
Yes ____ No ____
Are you a Lifetime Registrant under the Sexual Predator Status?
Yes ____ No ____
Briefly Explain Any Yes Answers____________________________________________
_______________________________________________________________________
Are You Interested In Working Toward Employment Or Obtaining A Job?
Yes_______
No_______
Page 2 of 3
Updated 8/15/2006ka
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Parent category: Business