KHOC Housing Application

Your full name

Date of Birth

Social security number

Driver's license number/State ID 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

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."

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