This application helps us match you with the right home.
Please answer honestly and completely. All information is kept confidential.
Basic Information
If you are currently unhoused, please write “N/A”
Have you ever been convicted of a crime?
Yes
No
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Veteran Status
Are you a U.S. Veteran?
Yes
No
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Do you currently receive VA benefits?*
Yes
No
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If yes, which type? (check all that apply)
Housing voucher
Disability compensation
Pension
Other
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Lifestyle & Preferences
Do you prefer a private or semi-private room?
Private (if available)
Semi-private
No preference
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Are you comfortable living in a shared space with other Veterans?
Yes
No
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Do you have a vehicle?
Yes
No
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Do you smoke or vape?
Yes
No
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Do you have a pet?
Yes
No
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Income & Support
Are you currently employed?
Yes
No
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What is your current source(s) of income?
Employment
VA benefits
SSI/SSDI
Support from agency/case manager
Other (please specify):
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$
Are you working with a case manager or housing coordinator?
Yes
No
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Trusted By 1,000's of Businesses
We're proud to fiscally sponsor the work of Next Mission Housing.
They've built a model rooted in dignity, structure, and the kind of support Veterans truly deserve.
- Founder, Grooming Greatness
Next Mission Housing™ is powered by Leaders Lifting Leaders®, an organization committed to building Generational Wellbeing™ in underserved communities.