Housing Ministry Application - Steele Creek Church

Your name *

Email address *

Address *

Phone number *

How many people currently are in your household

min: 1 / max: 20

This number should include both adults and children

Please provide SS Numbers for adults (Example: Name: xxx-xx-xxxx)

This is to help us should you move forward in the program. We will need to do a background check.

Green Card (If applies)

If you do not have one it's not a problem for us. We just need to know to better help.

Yes

In Process

Background Check:

This is a part of our process. Are you willing to be linked to a background check?

Yes

Other

List most recent housing situation with dates:

Rent, Own, Homeless,Emergency Housing,Living with family/friends, treatment center,Hospital,Jail,other

Are you currently being removed, evicted,or asked to leave your current living space?

Yes

Briefly tell us an overview of how far behind you are:

This will help us know how to better help you.

Briefly tell us about your total bills you have to pay each month

Please list each one. This will better tell us your story.

Do you have other family or extended family members in the area? *

Yes

Emergency Contact Information *

Please give name and phone number for each

Next Step: Please tell us about your employment status

We need to know what a beginning point is so that we can best assist in moving forward.

Describe your current employment situation. Include the name of the company. *

We would like to know where, what hours or shift, how long you have been there and rate of pay.
(Example- Sam's Club, Address, 1st shift 7am-3pm, 4 years, $16 per hour or salary)

Current Working Status: *

We need a good starting point to know how to help.

Full-Time 40 hours or more per week

Part-Time 30 hours or less per week

Very Part-Time 20 hours or less per week

Not working at this time

Commision Base Only

Other

What is your total monthly household income? *

Please include the total amount you receive for you, your spouse, or any other person that will be living with you in our housing program. Include the name of the income stream and the amount received

What was your total annual household income last year? *

Include all sources of income for each person that will be living with you.

Would you allow us to call and verify your employment? *

This happens between the 1st and 2nd interviews

Yes

Other forms of Income: *

Please Check All that Apply

Child Support

SSI/SSDI

Food Assistance

Wick

Retirement

Work First

Medicare/Medicaid

Public Housing

Section 8

VA Benefits

Other Housing Subsidies

Other

Do you have any special medical needs that need accommodation? *

Our desire is to make sure that we are able to meet your needs effectively.

Yes

Please list for us your most recent church information *

Please include the name of the church and the contact info for the pastor of the most recent church you have attended.

Please provide at least 2 references. *

Please include full name, phone number, email, and a description of your relationship with this person. Please do not use family members, or pastors and staff from Steele Creek Church. We may contact these references as a part of the application process.

Please describe the reasons you need housing assistance.

Include all the factors that have contributed to your current need.

Our Agreement

One last thing that is very important for you and to us.
Our desire is to serve each person that the Lord sends to us with the highest level of honor and respect. Our ask in the process is simple, that you be as honest and transparent as possible. None of us are perfect and we all have had seasons where we needed help. Please read the statement below and sign should you agree.

The information contained in this application is correct to the best of my knowledge. I give permission and authorize Steele Creek Church to contact and verify any and all information contained within this application. This can include but not limited to contacting persons or agencies listed here to seek information about my character and fitness to receive assistance.

Lastly, should my application be accepted, I agree to abide by the policies and procedures detailed in the housing agreement. I have read carefully, reviewed this release, and know and understand the contents. I am signing this release below of my own free will. This is a legally binding agreement between Steele Creek Church, its leadership and myself.

PLEASE TYPE YOUR NAME BELOW AND DATE:

Your Full Name Please

This will serve as a digital signature