Refugee Resettlement Support Application

Refugee Resettlement Support Application — Form Fields

This applications template includes 10 fields. Apply for resettlement support services including housing, employment, and language assistance. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address (email, required)
• Phone Number (text, required)
• Current Location (text, required)
• Country of Origin (dropdown selection, required) — options: Afghanistan, Syria, Sudan, Somalia, Myanmar, Democratic Republic of Congo, Other
• Number of Family Members (number, required)
• Services Needed (checkboxes, required) — options: Housing Assistance, Employment Support, Language Classes, Childcare, Medical Referral, Legal Aid, School Enrollment
• Date of Arrival in Country (text, required)
• Do you have a case manager or sponsor? (multiple choice, required) — options: Yes, No
• Additional Information or Special Needs (long text, optional)