Housing Assistance Application

All fields marked with an asterisk (*) are required. Sensitive fields are encrypted in transit and at rest.

Privacy Notice: Fields marked Sensitive are stored with additional encryption and shared only with your explicit written consent.

First Name *

Last Name *

Date of Birth * Sensitive

Social Security Number * Sensitive

Sensitive: Your SSN is encrypted and used only for benefits eligibility verification.

Phone Number *

Email Address

Monthly Household Income

Current Address

Reason for Seeking Housing Assistance

I consent to share my information with partner agencies for the purpose of housing placement and supportive services. *

By submitting, you confirm that all information is accurate to the best of your knowledge. Your data is protected under our Privacy Policy and Washington State privacy law.