Housing
Pre-Application

Use this secure online form to tell us about your housing needs, including interest in shared housing or other housing assistance. Submitting this form does not guarantee housing, eligibility, acceptance, or placement. It helps us understand your situation and determine whether Kismet Village services may be a potential fit.

First name

Last name

Email

Phone

Preferred Choice Of Contact

Phone

Email

City and State where you are currently staying

Preferred location(s) or area(s)

Preferred move-in timeframe

0-30 Days

1-30 Months

3-6 Months

More than 6 Months

Monthly budget or available funding for housing, if known

Total number of people in your household, including you

Ages of household members

Do you currently have a source of income, benefits, housing assistance, or other funding that may be available toward housing?

Yes

No

Are you interested in shared housing?

Yes

No

Maybe - I'd like to learn more

If Yes or Maybe, what would be important to you in a shared-housing arrangement?

If you would like, briefly identify the type of income, benefit, assistance, or funding

Are there any housing-related circumstances or concerns you would like us to know about so we can better understand what type of housing assistance may be appropriate?

Do you currently work with a case manager, social worker, or service provider?

Yes

No

If yes, provide their name, organization, and contact information. Providing this information does not authorize Kismet Village to contact this person. We will obtain your permission before contacting a provider when authorization is required.

Is there anything else you would like us to know about your housing needs or situation?

Acknowledgment

I understand that this Housing Pre-Application is an initial inquiry and does not guarantee housing, eligibility, acceptance, or placement. I understand that additional information or documentation may be requested if I choose to continue with the housing process. I certify that the information I have provided is accurate to the best of my knowledge.

Type Name

Date

Month

Day

Year

Privacy Notice: Please do not provide Social Security numbers, bank or payment information, medical records. goverment identification numbers, passwords, or other highly sensitive informatin on this pre-application.

What Happens Next

Kismet Village will carefully review the information you provided in your pre-application. Our team may reach out to request additional information or documentation to better understand your situation. Please keep in mind that submission of this form is an initial step and does not guarantee housing, eligibility, acceptance, or placement.