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Quick-Screen Questionnaire
First Name
*
Last Name
Phone
*
Email
*
Do you have a specific rental in mind?
*
Yes
No
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How will your rent be paid?
*
🧾 I pay rent myself (out of pocket)
🏛️ A housing program helps pay my rent
🤔 I’m not sure
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How many bedrooms are you looking for?
*
1
2
3
4
5
6
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Are you looking for a house only, or would you consider an apartment as well?
*
Apt OR house
House only
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Which housing program will be assisting with your rent?
*
Unknown
Rapid Rehousing
RISE
RISE Plus
FLEX
Voucher
Permanent Supportive Housing (PSH)
Targeted Affordable Housing (TAH)
CareerMap
Inclusionary Zoning (IZ)
Other
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How much of your rent are you responsible for paying out of pocket each month (not the full rent)?
*
$0.00
$1 - $200
$201 - $400
$401 - $600
$601 - $1,000
$1,001 - $1,500
More than $1,500
Unknown
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For most subsidy programs, the tenant portion is usually around 30% of your gross monthly income, not the total contract rent.
What is your gross monthly income?
*
$
What is your source(s) of income?
*
Select more than one if applicable.
N/A - $0 income
Employment
Social security
VA
TANF
Child support
Other
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What is your maximum monthly rent budget?
*
$
If needed, do you have anyone that would be willing to co-sign for you?
*
Yes
No
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How will the security deposit be paid?
*
Personal Funds — out of pocket
Family — third-party assistance
Housing Authority – security deposit assistance
Nonprofit — case management program assistance
ERAP — emergency rental assistance program
Installment — payment plan requested
Unknown — pending confirmation
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Employer or Employed by
Job title
Years on job
0
1
2
3
4
5+
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Additional months on job (0–11)
0
1
2
3
4
5
6
7
8
9
10
11
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How many adults will be living in the household?
*
1
2
3
4
5 or more
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How many children or dependents will be living in the household?
*
0
1
2
3
4
5 or more
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Do you have pets?
*
Yes
No
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Are you working with a Case Manager?
*
Yes
No
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Completed by
*
Alexis
Chris
Kiril
DCYPS
Mike K
Mubashir
Nadia
Raphael
Chatbot (AI)
Test
Webform
Other
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Is a property manager involved?
*
Yes
No
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List is empty.
Landlord name
Landlord mobile
Landlord email
Property manager name
*
Property Manager mobile
*
Property manager email
*
Subsidy, voucher upload
Submit
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