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To qualify for housing, begin by completing the application below. If you have any questions, please speak with your provider or call us at 832-847-1402

Alternative Option: If preferred, you can download and print the application, then complete and email it to us at [email protected]

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Date of Birth

Age

Phone

Select all that apply

Vet
ID Card
SS Card

Agency that works with you

Agency Phone

Agency Email

Income

Select all that apply

Working
DOC Housing Voucher
HARP Funding
SSI
SSDI
Other (specify below)

Other Income

Healthcare

Health Insurance

Medicaid
State Health
Other (specify below)

Other health insurance

Any Chemical dependency past or present and do you receive services? Where?:

Housing History

Times you lost housing and why:

Debt or LFOs:

Children and ages:

Incarceration of Arrest History

List any charges pending

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Charge 1

Charge 1 County

Charge 1 Status

Charge 2

Charge 2 County

Charge 2 Country

DOC Number

Are you working with any other organization or case managers are they helping with resources?

Work history

Are you working or looking for work?

Type of Work

Do you plan on attending school or training and what type of education?

Any Mental Health services or medication in the past or present? Please list.

What should we know about you to assist you? Please feel free to write in comments.

Emergency Contacts / Family or Friends

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Person 1 Name *

First

Last

Person 1 Relationship

Person 1 Address

Address Line 1

City

State

Zip Code

Person 1 Phone

Person 2 Name *

First

Last

Person 2 Relationship

Person 2 Address

Address Line 1

City

State

Zip Code

Person 2 Phone

Layout

Resident Signature (Reserved to be signed in person)
.

Counselor Signature (Reserved to be signed in person)
.



Phone

(832) 847-1402



Email

[email protected]

Nicholas & Cecilia’s House of Hope Foundation

ADDRESS:
15814 Champion Forest
Dr #178, Spring TX 77379

PHONE: (832) 847-1402

WHATSAPP: Click to Message

Nicholas & Cecilia’s House of Hope Foundation
is a registered 501(c)(3) nonprofit organization.

EIN #: 923044445