Housing Assistant

HOUSING ASSISTANCE REQUEST

Full Name*

Phone Number*

Email Address*

Preferred Contact Method*

HOUSING NEEDS

Who needs housing*

Self

Self & Family

Family Member

Other

Number of people needing housing*

Number of children

Preferred location(s)*

Maximum monthly budget*

INCOME & ASSISTANCE

Do you have income or financial assistance for housing? *

Yes

No

Pending

Prefer Not to Answer

ADDITIONAL INFORMATION

Is there anything else you would like us to know about your housing needs?*

CONSENT & AGREEMENT*

I understand that submitting this form does not guarantee housing or placement. Housing availability and final approval are determined by participating property owners and housing providers.

I authorize DNA Solutions Group to contact me regarding my housing request.

Helping individuals, community organizations, and property owners navigate the path to stable housing through professional housing navigation, coordination, and community partnerships.

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