This nonprofit template includes 11 fields across 2 pages. Collect housing assistance requests for shelter and rental aid. Free to customize and use on ZenBuild.
Full Name (text, required)
Email Address (email, required)
Phone Number (text, required)
Address (text, required)
Type of Assistance (dropdown selection, required) — options: Temporary Shelter, Permanent Housing, Rental Assistance, Utility Assistance, Move-In Costs, Home Repair
Household Size (number, required)
Monthly Income ($) (number, required)
Describe Your Housing Situation (long text, required)
Are You Currently Homeless? (multiple choice, required) — options: Yes, No, At risk of homelessness
