Transitional Housing Program Application
The Missoula YWCA is an Equal Opportunity/Employer agency. Auxiliary aids/services are available upon request for individuals with disabilities. For inquiries, write the Missoula YWCA at 1130 W. Broadway, Missoula, MT 59802, or call (406) 543-6691. Thank you for your interest in YWCA programs.
A United Way Agency
The YWCA Transitional Housing Program provides housing on a sliding fee scale, case management, life skills instruction, and support services. The YWCA Transitional Housing Program is committed to supporting homeless women and their children as they work towards self-sufficiency and independence. The program offers women the opportunity to gain knowledge, education, and skills in a variety of areas, while working on goals that will assist them in obtaining permanent housing and achieving economic security. The Transitional Housing Program is not a basic landlord-tenant relationship; it is an independent living self-sufficiency program.
Please complete the entire application. Completing this application does not guarantee that you will be accepted to the Transitional Housing Program. You will be contacted by telephone to set up a meeting with a staff person from the Transitional Housing Program. If you do not have a telephone number listed, you will be contacted through the mail. It is YOUR RESPONSIBILITY to alert us to any change in your contact information.
It is the YWCA Missoula's policy to not discriminate against any persons based on race, physical or mental disability, religion, national origin, sex, age, creed, physical condition, sexual orientation, gender identity, or expression.
To be placed on the interview waiting list you will need to:
1. Bring in proof that you have signed up with the Missoula Housing Authority
2. Bring in confirmation that you have signed up with Human Resource Council (apply online at www.housing.mt.gov)
3. Homeless Verification: The family must be homeless to qualify for services;(by HUD’S definition, a homeless family is: one that is forced to spend the night in a place not meant for human habitation, in an emergency shelter, living in transitional housing or supportive housing for the homeless or having been discharged from an institution with a lack of resources and the support network needed to obtain access to housing, being evicted within a week from a private dwelling and no subsequent residence has been identified, fleeing from domestic violence).
If you need assistance, please contact the Ada’s Place Manager as soon as possible at 543-6691, ext. 107.
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By completing the following application, you will provide information that will assist the YWCA in determining your eligibility.
Name ______Today’s Date ______
Mailing Address ______Zip ______
Phone ______Other Contact/Message Numbers______
Birth date ______City /County your original came to Missoula From ______
*It is YOUR responsibility to alert us to any changes in your contact information *
General Information
1. How long have you lived in this community? ______
2. Who referred you to the YWCA? ______
3. Are you a single head of household? Y N
4. Do you have any pets? Y N
5. If, so is it a service animal? Y N
6. Are you a veteran? Y N
7. Have you ever been arrested? Y N
8. If so, please give a brief explanation and the date of the arrest: ______
9. Are you homeless or about to become homeless (can include living with a friend/family member)? Y N
If yes, how long have you been homeless? ______
10. Are you currently employed? Y N
Full time? _____Part time? _____
______
Housing Status
1. Are you signed up with Missoula Housing Authority? Y N If YES, when did you turn in your application? ______
2. Have you signed up with other low income/subsidized housing agencies? Y N If YES, please list: ______
______
3. Please describe your current living situation (where you are living, how long, circumstances that led up to you becoming/about to become homeless, etc.): ______
______
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Optional: for statistical purposes only
Please check on box only. If two or more ethnic categories are applicable, choose the one category with which you most closely identify.
______Hispanic or Latino ______Black or African American
______American Indian or Alaska Native ______Asian
______Native Hawaiian or Other Pacific Islander ______White or Caucasian
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Family Size and Income
GROSS CASH INCOME RECEIVED BY EACH FAMILY MEMBER DURING THE LAST SIX MONTHS.
Please list all of the people living in your home during the past six months who are related by blood, marriage, or adoption and list all of your children whether or not they have been living with you (disregard income for those children that are not currently living with you). Include yourself.
FamilyRelationship / Full Name / Age / Monthly
Income From
All Sources / Source(s) of
Income
1. Who from the list above will be living in the transitional housing apartment with you?
______
______
2. Is there anyone other than those listed above who will be staying with you? If so, how are you related?
______
3. If you have children please describe the custody/living arrangements (i.e., parenting plan/ visitation/arrangement?
______
Personal History/Information
1. Have you experienced violence in any form in the last two years? Y N
2. Do you currently feel safe? Y N If NO, please explains? ______
Reference Information
Please provide 3 references (examples: co-workers; family; friends; counselor; landlord; teacher; other non-profit organizations; case manager). **These references will only be checked after you are interviewed for the Transitional Housing Program.
Name: ______Phone: ______
Address: ______City: ______State: ______
How does this person know you? ______How long? ______
Name: ______Phone: ______
Address: ______City: ______State: ______
How does this person know you? ______How long? ______
Name: ______Phone: ______
Address: ______City: ______State: ______
How does this person know you? ______How long? ______
Please provide one landlord reference:
Property Manager: ______Phone: ______
Address: ______Apartment Number: ______
City: ______State: ______
When did you rent from them? ______
Applicant Statement
My signature below certifies that all information on this application is true, correct, and complete to the best of my knowledge, and contains no willful falsifications or misrepresentations. I authorize the YWCA to contact my present and past employers and the references listed above to obtain information deemed appropriate to consider my application for the Transitional Housing program.
______
Applicant Signature Date
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