Housing Assistance Program Application (HAP)

Checks will be issued 4-6 weeks from approval.

 

How does Adequate Housing For Missourians Work?

 

Text Box: Household Income: What is your TOTAL household income? $____________.00 What is your monthly rent? $____________.00 Please check all the sources of your income: ___Employment ___Child Support ___Social Security ___Social Security Disability ___TANF-Cash Grant ___Food Stamps ___Pension ___Unemployment ___F/T Student AHFM is committed to making decent, safe, accessible and affordable housing available to all.

Text Box: Education: ___Elem/Jr. High ___Some High School ___High School/GED ___Some College ___Tech School ___Grad. Degree ___Other___________________________ ___Veteran Text Box: Household Information: Print Name Social Security # Date of Sex Age Birth ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Text Box: Applicant Information: Contact #:__________________________ Social Security #:_________-_______-___________ Name:______________________________________________________________ Last Name First Name Current Address:_____________________________________________________ City:_________________________________________Zip Code:_____________

Check All that apply:

Marital Status:     ___American Indian                          Disability Information:

___Single                      Alaskan Native                            ___Mental

___Married           ___Black (not Hispanic)                    ___Physical

___Divorced         ___White (not Hispanic)                    ___Drug/Alcohol

___Widowed        ___Hispanic                                         ___HIV/Aids

                                ___Asian/Pacific Islander                 ___Other____________

                               

 
 


Text Box: DOCUMENTS THAT MUST ACCOMPANY ALL APPLICATIONS: ___Legible copy of picture ID ___Soc. Cards for all in house ___Recent gas & electric bill ___Proof of Income with 30 days OTHER DOCUMENTS REQUIRED: Rental Deposit: ___2 letters of recommendation ___Notarized Letter from new landlord: stating your name, address of new unit, monthly rent & deposit required Those moving into Section 8: ____Lease ___Move In Slip Rental Assistance: Notarized letter from landlord stating: your name, address, monthly rent, the month and amount you owe for. Late fees must be listed separately.

 

Text Box: Where can I do my community service? Your community service can be done at any not-for-profit agency of your choice ( your child’s school, church, food pantry, etc. IT CANNOT BE A DAYCARE, or you may contact one of the following: American Red Cross 314-516-2876 Doorways 314-535-1919 Equal Housing Opportunity Council 314-534-5800 Operation Food Search 314-726-5355 St. Louis Crisis Nursery 314-768-3898 St. Louis Dream Ctr 314-381-0100 St. Patrick Ctr 314-802-0700

 

Text Box: NEW LANDLORD INFORMATION: Monthly rent of new unit: $____________.00 Total Deposit Required: $____________.00 Address of New Unit:____________________________________________ City:__________________________ _____ Zip Code:______________ County: ___St. Louis City ___St. Louis Co ___St. Charles ____Other Name check is to be made out to:________________________________________ Address:_________________________________________________________ Landlord Name:_______________________________ Phone #:________________

Text Box: RENTAL DEPOSIT ASSISTANCE - Community Service: If you are disabled, employed full time (paycheck stubs required) Or a full time student (transcript required) you will NOT be required to perform community service. All others are required to do an average amount of community service for the amount of assistance they are seeking. This promotes a “hands up” program as opposed to a “hand out”. This, coupled with your taking care of your new apartment will ensure that your deposit will be refunded to you when you move. If your deposit is NOT refunded to you, due to damages or rent owed, you will not be eligible for assistance until 3 years from the date of your approval.

 

 

 

 

           

Text Box: How Many Community Service Hours must I perform? $100.00 - $200.00 19 Hours $201.00 - $300.00 31 Hours $301.00 - $400.00 44 Hours $401.00 - $500.00 56 Hours $501.00 - $600.00 69 Hours Text Box: How do I prove I did my community service? Once you complete the number hours required, you ask the not-for-profit to type you a letter, on their letterhead, stating your name, the dates you performed your community service, total hours completed, what tasks you did, who supervised you and their telephone number.

 

 

 

 

 

 

 

 

 

This formed must be signed and returned with your application.

 

NOTICE TO THE PUBLIC

 

We collect personal information directly from you for reasons that are discussed in our privacy statement.  We may be required to collect some personal information by law or by organizations that give us money to operate this program.  Other personal information that we collect is important to run our programs, to improve services for homeless persons, and to better understand the needs of homeless persons.  We only collect information that we consider to be appropriate.  You may request a copy of our full Privacy Notice.

 

 

_____________________________________                                                   ______________________________

Applicant’s Signature                                                                                                                         Date

 

 

 

 

Text Box: Please note: NO ASSISTANCE IS GUARANTEED. IT IS CONTINGENT UPON FUNDING AVAILABILITY. OUR PROGRAM OPERATES ON A FIRST COME, FIRST SERVE BASIS.

 

 

Please read each statement and place your initials next to the statement to show you have read each one.  Thank you.

 

______Adequate Housing for Missourians (AHM) cannot require religious instruction, counseling, or worship as a basis for assistance.

 

______AHM assures applicants that they have the right to be free from sexual harassment.  Any form of harassment should be reported to the        Program Manager immediately.

 

______AHM has the right to deny any application if any or all of the following should occur:  *  Foul or abusive language towards staff

·         False information given

 

______I understand that if I turn in an incomplete application, either by mail or appointment, I will receive a 30 day sanction before I can re-submit

            My application. (Please note:  if you e-mail your application - it will remain inactive until we receive all your documentation)

 

______Should my application be denied for any reason, I have the right to file a grievance as follows:  Write a letter to the Director and mail to

The above address.  If my grievance is about the Director, I will address the envelope to the Board of Directors and mail to the above address.

 

______I understand that  my community service MUST be completed, and I must attach a letter to my application from the not-for-profit stating            what I did,      the dates I did it, total hours completed, the person’s name who supervised me and their phone number. 

            This must be on their   letterhead.

            (if you are disabled or employed >30 hours a week or you are a full time student(12 credit hrs) -community service is NOT required.

 

______Once your file receives FINAL approval, a letter will be sent to you and my landlord stating for what I have been approved for.  

            I AM NOT TO CALL THE OFFICE.  My landlord will then receive a check within 6-8 weeks from the date of my notification letter.

 

 

By signing below, I am communicating that I have read all the above statements and fully understand the process of AHFM’s program.

 

 

_______________________________________________                                                  _____________________________________

Applicant’s Signature                                                                                                           Date

 

 

EMERGENCY FUND NETWORK RELEASE OF INFORMATION

 

The Emergency Fund Network is a group of agencies that work together to provide services to low-income individuals and families in St. Louis City, St. Louis County and St. Charles.  This group includes shelter, housing, food, state, private and non-profit social service agencies, and faith group organizations.  I give the participating Emergency Fund Network agencies and their representatives, my permission to share some or all of the following information regarding my family and me.  I understand that this information is for the purpose of assessing our needs for housing, utilities assistance, food, counseling and/or services.

 

The information may consist of the following:

 

Ÿ         My financial situation, to include the amount of my income and any savings of money and/or food stamps I may have.  This information may also include debts I owe for utilities, rent, etc.

Ÿ         Physical or mental health problems, which may interfere with my ability to maintain shelter, housing, utility payments and/or care of my children.

Ÿ         Identifying and/or historical information regarding myself and members of my household.

 

I understand that participating service providers will treat this information in a professional and confidential manner.  Furthermore, I understand that the network members have signed an agreement to maintain confidentiality regarding summaries and team presentations.  I further understand that the release of this information does not guarantee that assistance will be provided - without the information my case CANNOT be presented to the Emergency Fund Network for consideration.

 

____________________________________                                                                                    ___________________________

Applicant’s Signature                                                                                                                         Date

 

This release of information remains in effect for a period of 1 year from the date of applicant’s signature or until revoked in writing.

 

Service Providers Network Members

(this list may change from time to time as new members are added)

 

Adequate Housing for Missourians, American Red Cross, Ecumenical Housing Production Corporation, Housing Resource Center, Human Development Corporation, Lutheran Family and Children’s Services of Missouri, Missouri Division of Family Services, Presbytery of Giddings-Lovejoy, Salvation Army, St. Louis Metro Baptist Association, St. Patrick Center, STEP Incorporated, United Way of Greater St. Louis, Cardinal Ritter Institute and Jewish Family and Children Services.