HIV Housing Needs Form
Help us understand your current housing situation and preferences so we can better support your needs.
What is your current housing status?
*
Stably housed
Temporarily housed (e.g., staying with friends/family)
Unhoused (e.g., shelter, street, car)
Other
Please describe your current living situation.
*
What type of housing do you prefer?
*
Apartment
Shared housing
Single-family home
No preference
Other
How urgent is your need for new housing?
*
Not urgent
1
2
3
4
Extremely urgent
5
1 is Not urgent, 5 is Extremely urgent
Do you have any accessibility needs?
*
Wheelchair accessible
No stairs
Accessible bathroom
Service animal accommodation
None
Other
Which locations or neighborhoods do you prefer?
*
What is your monthly income affordability range for housing?
*
Please Select
Under $500
$500 - $1,000
$1,000 - $1,500
$1,500 - $2,000
Over $2,000
When would you ideally like to move?
*
Please Select
As soon as possible
Within 1 month
Within 3 months
Within 6 months
Flexible
What support services would be helpful to you?
*
Case management
Transportation assistance
Healthcare referrals
Mental health support
Substance use support
Financial counseling
None
Other
Is there anything else you would like us to know about your housing needs?
Submit
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