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Home
About
Program Areas
Engage
Events | Workshop | Conference
Scholarships
WEN Book Club
Careers
Contact

Contact Support Team
Membership Application Form
Volunteer Assignment Form
Non-Disclosure Agreement
Start A Chapter
Family & Community Support

Housing Assistance Intake Form

HOUSING INTAKE FORM

Please bear in mind this is the initial intake form to help us begin the housing search for you. This does not preclude you from completing another application from the housing owner/corporation/representative.

Date / Time *

Date

Time

HOUSE SEARCH: Are you looking for housing? *

YES
No

Why are you looking for housing? *

When did your start looking for housing? *

What is your current living situation? *

Shelter
Squatting with a friend
Squatting with family member(s)
Other (explain below)

What are your housing needs? *

Rent an apartment
Rent a room
Buy a house
Other (explain below)

What was the geographic location of your last residence? *

How long where you in your current or last residence? *

What attempts have you made to find housing? *

How many places have you contacted? *

Have you received any reply from them? *

YES
NO

If not, why? *

How much are willing to pay? *

REFERRAL 1 (HOUSING): Please list two persons not related to you who know about your housing condition. Name *

First

Last

Email *

Phone *

REFERRAL 2 (HOUSING) : Please list two persons not related to you who know about your housing condition. Name (copy) *

First

Last

Email *

Phone *

EMPLOYMENT – Are you currently employed? *

YES
NO

What is your role at work? *

At you satisfied with your employment? *

YES
NO

Are you willing to acquire additional skills in Information Technology? *

YES
NO

REFERRAL 1 (JOB): Please list a person not related to you who know about your employment history *

First

Last

Email *

Phone

EDUCATION LEVEL – What is your qualification? *

High School Dropout
High School Diploma
Associate Degree
Bachelors Degree
Masters Degree
Doctorate and beyond

Are you interested in obtaining a GED? *

YES
NO

BACKGROUND INFORMATION – Have you ever been convicted of a felony? (copy) *

YES
NO

If yes, How many conviction(s) do you have? *

What is the nature of offense(s) leading to conviction(s)? *

How recently was/were such offense(s) committed? *

Have you expunged any of the above offenses? *

YES
NO

Have you ever served in the armed forces? *

YES
NO

PERSONAL INFORMATION *

First

Last

Your Email *

Your Phone Number *

Signature *

Clear Signature

Please note that your completed application will be filed in the order it is received. By completing this form, you give WEN permission to make your completed intake form accessible to anyone desiring to search for, verify, and assist you in your housing need.

About Us

World Ebony Network (WEN) is dedicated to reinforcing the enduring and noble philosophies, principles, practices (3Ps) of our fore fathers and appreciating the good aspects of other heritages. Our mission helps us to achieve our 3 part vision: to plead the socio-economic causes of people of African ancestry; to reconcile the estrange cultural relationships of people of African ancestry; and to appreciate the good aspects of other heritages.

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Contact Support Team
Membership Application Form
Volunteer Assignment Form
Non-Disclosure Agreement
Start A Chapter
Family & Community Support

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