Homeless Prevention Interest Form

Please submit only one application per household.

Due to high demand, our Homeless Prevention Program is currently at maximum capacity. If you would like to be added to our Program Interest List to be considered for future program openings, please fill out this pre-screening. Households who pass this initial pre-screening will be contacted to collect more information to determine final eligibility for the Homeless Prevention Program Interest List.

To be contacted, please enter either an email or phone number (or both). Communication will not be sent via postal mail. We will only contact you by phone or email.

Households who do not pass the initial screening are invited to apply again when there are changes to your housing situation. (Number of people living in the home, changes in income, etc.)

Name(Required)
Address(Required)
We collect your address solely to determine eligibility for our services. Some programs are available only to residents of certain areas of Whatcom County.
What is your preferred language?(Required)

Amount before taxes on paycheck
Amount after taxes on paycheck
This field is hidden when viewing the form
Do you receive HEN/ABD through DSHS?(Required)
Is anyone in your household a veteran?(Required)
Is anyone in your household under 18 or over 60 years of age?(Required)
Does any household member have a disabling condition?(Required)
(Examples could include: recent increase or decrease in income, the receiving of a pay or vacate notice, the addition or removal of someone from your household, etc.)
If you are currently renting, are you in subsidized housing?(Required)
Subsidized housing means you have a housing voucher, or live in a unit that charges a percentage of your income for rent, (usually 30%)