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Take the First Step Towards Living in a Warm and Inviting Community Environment

Shared Housing Application

If you’re interested in living in one of the clean, well-maintained houses of Golden Homes, LLC, please apply below. 

For more information about the application process, please feel free to call or email us.

Application Form

Date*

Name*

Phone*

Email*

Birth Date*

Age*

Veteran?*

Form of Identification*

Income Source?*

Do you have plans for schooling or training?

Healthcare Source?*

Any Mental Health issues past or present? Do you receive services?*

Any Chemical dependencies past or present? Are you receiving services?*

Barriers to housing*

Debt*

Other*

Incarceration or Arrest history _ Any charges pending*

County*

Status*

Charge*

County*

Status*

DOC Number*

Are you working with any other organizations or case manager? Are they helping with resources?

Emergency Contacts/Family or friends _ 1*

Relation*

Address*

Phone number*

2

Relation

Address

Phone number

Anything else we need to know about you?*

How did you hear about us?*

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