Homeprovider Application

Homeprovider Application Form

Prospective home providers use this form to apply to become home providers.

Name(Required)
Email(Required)
Please note: our program only serves home providers in Baltimore City and Baltimore County.
What county is your home located in?(Required)
Please note: Our program only serves Home Providers in Baltimore City and Baltimore County.
Gender(Required)
What best describes your household?
MM slash DD slash YYYY
Why do you want to share your home now?(Required)

Has your decision to look into home sharing been influenced by your mortgage payments, foreclosure, or risk of foreclosure?(Required)
Do you own your home?(Required)
If renting, please include a letter from your landlord indicating permission to sublet.
What is your marital status?(Required)
Have you ever had a problem with alcohol or drugs?(Required)
Have you ever been convicted of a crime?(Required)
Please indicate your employment status:

Examples: Employment, SSI, pensions, public assistance, etc. Please provide us with a copy of your documentation at the time of your interview.
Your highest level of education completed:(Required)

Your race (for grant reporting purposes only) – Please mark all that apply:(Required)

Information for Homesharing

Are utilities included?(Required)
Are you investigating other housing possibilities?

BY COMPLETING AND SUBMITTING THIS FORM, I AGREE TO THE FOLLOWING:

All of the information above is correct to the best of my knowledge. I have read and understood that a $50 non-refundable application fee is due when I am interviewed after submitting this application (this is only paid one time). If a suitable match is found for me, I agree to pay St. Ambrose Homesharing the balance of 1/3 of one full month’s rent due at the time of the match meeting, usually 2 weeks after move-in. In the case of nonpayment of program fees, I understand that I will be billed for all Homesharing services rendered to me.
I agree to the above statement(Required)

CONSENT TO OBTAIN INFORMATION FORM

Please list the names of four people who have known you for AT LEAST FIVE YEARS that can serve as a personal reference for you. Include a former roommate or landlord and a combination of the following – one family member, professional person, associate, clergy, or friend.
If applicable, choose the most recent person with whom you have lived.
This field is for validation purposes and should be left unchanged.