Application – Kitsap Homes of Compassion

You may use this form to apply for the Kitsap Homes of Compassion shared living program. Expect to hear from KHOC staff within three working days of your submission. Please call, text, or email Kristin Cole–our Housing Coordinator–if you have any issues with this form, or other questions about applying. kristin.cole@kitsaphoc.org; 360-209-3235.

Your full name Date of Birth Social security number Your email Your phone number Your current address (or where you are currently sleeping) City, State & zipcode Are you currently homeless (sheltered or unsheltered)? Yes (sheltered)Yes (unsheltered)No Monthly Income Source(s) of Income (examples; SSI, SSDI, employer, none, etc.) Criminal History (list all felonies, and any misdemeanors from the past 3 years) Substance Use (describe your history with drugs & alcohol, include date of last use) Are you interested in receiving case management services to help remove barriers you may have encountered when attempting to find and keep stable housing? YesNo Reference Name (someone who knows you well) Relationship (how do they know you?) Reference Phone number Emergency Contact Relationship (how do they know you?) Contact phone number Driver's license number/State ID number Do you have a car? YesNo If yes enter Make, Model, Year: Any additional details about your situation *Required* "I attest that I have answered everything in this form truthfully. I agree to have a representative of Kitsap Homes of Compassion reach out to me for further assessment by phone."