Pre-Application Form

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MFAST Housing is currently accepting pre-applications for their affordable housing program. Please fill out this form completely and someone will follow up with you when housing becomes available in your area. ***SUBMITTING THIS FORM DOES NOT GUARANTEE YOUR SLOT IN THE HOUSING PROGRAM.

YOUR name
your Email
Your Phone Number
who are you applying for?
Please Select One
  • Myself
  • Family Member
  • Client (I am a Case/Social Worker or Sponsor)
  • Other
Client's Name
client's e-mail (if available)
client's Birth Date
wHAT IS THE CLIENT'S primary language?
wHAT IS THE cLIENT'S marital status?
Please Select One
  • Married
  • Civil Union
  • Divorced
  • Seperated
  • Widowed
  • Never Married
Client's Gender
Select One
  • Male
  • Female
  • Female (pregnant)
client's Current Living Situation
Homeless shelter
Homeless(i.e. Street)
Hospital
Private Residence
Residential Care/Treatment
Prison/Jail
Single Room Occupancy

Reason for leaving

Has the client been homeless within the last six months?
Yes
No
is the client at risk of homelessness?
Yes
No
How many of the last 30 days HAS THE CLIENT been in a controlled environment?
What type of housing is the client looking for?
Veteran Housing
Transitional Housing (from jail, etc.)
Elderly Care Housing
Special Needs Housing
Sober Housing
Independent Senior Living
Student Housing
Other
bedroom type the client is interested in?
Private Bedroom
Shared Bedroom
No Preference
does the client smoke?
Yes
No
Does the client have a violent criminal record? If yes, explain
is the client on Probation or parole?
Please Select One
  • Yes - Probation
  • Yes - Parole
  • No
If Yes - enter probation or parole officer's NAme
Enter the Probation / Parole officer's phone Number if applicable
does the client have a pending court case?
Please Select One
  • Yes
  • No
Is the client drug free & Sober?
Please Select One
  • Yes
  • No
Is the client on prescription medication?
Please Select One
  • Yes
  • No
does the client have Medicaid?
Please Select One
  • Active
  • Not Active
  • Pending
  • Unknown
what does Client Needs Help With? (Check all that apply)
client's Employment status
Employed full-time
Employed part-time
Unemployed - looking for work
Not in labor force
Highest grade completed:
Which best describes the client's monthly income?
Please Select One
  • $650 or less
  • $700 - $900
  • $950 - $1000
  • $1000 +
What is the client's funding source?
Please Select One
  • SSDI
  • SSI
  • Voucher
  • Private Pay
  • Retirement
  • Salary
  • Other
If other income source - Plese explain
number of minors dependent on income?
Does the client receive state food assistance?
Is the client working with an agency, case manager, or Sponsor?
Please Select One
  • Yes
  • No
If so,what is their phone number or contact info?

Who referred you to MFAST Housing?

Case Worker
Nursing Facility
Probation/Parole
Self
Google Search
Facebook
LinkedIn
Are you interested in maintaining a sober lifestyle?
Yes
No
Not Sure
What do you think is the client's biggest or most challenging issue?
What specific assistance or support would best help the client reach their goals?
Is there anything else you would like to tell us about yourself or the client?
when would the client need to move in? 
City of preference (state of michigan):
if other - enter city below
Any other comments or questions?
Submit Pre-Assessment
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