Application Package Contents 1. Frequently Asked Questions 2. Qualifying Criteria 3. Statement of Independence 4. Proof of Homelessness Form 5. Promise Pointe Application *Please attach the following to this application: A. A copy of a Texas photo ID B. Income Verification C. Homelessness Verification D. Pet Documentation (if applicable) E. Vehicle Documentation (if applicable) 1
Applying for a Home Frequently Asked Questions We have prepared these Frequently Asked Questions to help answer questions you might have. Should you think of other questions, please do not hesitate to ask. 1. Who can apply to live in a Promise Pointe RV Home? a. You must have had a coordinated assessment within the past six months, be found eligible for permanent supportive housing and be referred by another homeless provider. b. You must have an income to pay rent as determined by Promise Pointe. There are no minimums or maximums, you just must be able to comfortably pay your rent. c. You must have lived in the Victoria area for the past year. d. We do not allow roommates. Families may be considered. Couples who both qualify separately are allowed. 2. How can I apply? All potential residents will be required to have completed a coordinated assessment within the past six months. Applicants must agree to a criminal background check. Coordinated Assessment is just one step in your housing search. Do not stop here! If a program has an opening for which you qualify, they will attempt to contact you directly. Be absolutely sure you have some way for us to reach you. If you are in case management with a program now, continue to work with your caseworker on your housing goals. Many programs in the community do not participate in the Coordinated Assessment process yet. As part of Coordinated Assessment, staff will provide you with a list of external resources that you can try to access on your own or with your case manager. 2
For more information or to verify eligibility, please call (361)571-2589. 3. What if I have a criminal record, will that eliminate me from the program? No! However, at this time we may not be able to place those who are registered sex offenders. Additionally, those who have a violent criminal record such as murder, attempted murder, accessory to murder etc. will be screened to ascertain compatibility with the community. We work closely with those that have a criminal record but make no guarantees of placement. 4. What housing options are available and how much do they cost? RV's: rent to be determined by Promise Pointe, plus monthly electric & propane costs Each home will include a fully functioning kitchen equipped with cooking supplies and refrigerator, bathroom with standup shower, separate bedroom with fresh linens and new bed, living and sitting area and ample storage space. 5. Can I have a pet in a Promise Pointe home? Promise Pointe residents may have one pet, depending on the location. Residents must acknowledge that they have received and understand the Promise Pointe Pet Rules. Residents will be responsible for complying with all of the pet rules and regulations from, the RV community in which they reside and the City of Victoria. 6. Will I be able to live independently? The purpose of Promise Pointe is for you to live independently. Currently, we do not provide case management and can only refer you to other services we are aware of in the city. We want to encourage you to pursue other avenues of support such as food stamps, food pantries, soup kitchens, etc. in order to make it easier on you to live on a very limited income. Qualifying Criteria Promise Pointe prohibits discrimination based on race, color, religion, sex, national origin, disability, sexual orientation, marital status or age. In reviewing the application, the following areas will be taken into consideration for each prospective resident. They include, but are not limited to the following: Section A: Must be over the age of 18 show proof of age (valid driver s license, state ID, military ID, etc.). Source of Income as a resident of Promise Pointe you must pay your rent in full and on time (failure to do so will result in fines and/or potential eviction). All applicants must have a verifiable, stable source of income. Applicants will show proof of income, which could be from employment, disability income, retirement income, etc. A minimum of three (3) personal references who are not family members are required. Applicant(s) must provide contact information with their application. Potential residents must complete the Promise Pointe Application Packet. Section B: 3
All applicants must execute a Lease Contract for a Promise Pointe home and the lease term may vary depending on program participation. Rent is due on all units in advance. You will keep your property clean and allow Promise Pointe staff to do regular inspections of your home. All applicants must follow the Promise Pointe rules. I meet the qualifying criteria or will provide all necessary information to meet the qualifying criteria. All information provided is true and accurate. I understand that any inaccuracy or incomplete information provided could cause my application to be rejected. Furthermore, I understand that any falsified information puts me in danger of having any housing offer made by Promise Pointe, or any executed lease terminated. Applicant s Signature Printed Name Date 4
Promise Pointe STATEMENT OF INDEPENDENCE Promise Pointe is an innovative program designed to provide independent, affordable, sustainable housing with dignity to those who are experiencing homelessness. It is the expectation that all applicants will be able to live independently as single occupants, husband/wife couple, established domestic partnership or family unit in an RV in a community environment. The occupant(s) will be expected to maintain a clean and orderly home. Promise Pointe staff will make random and periodic inspections to insure the home is kept in an orderly fashion. Promise Pointe does not provide case management services or counseling. All services that an applicant may need will have to be obtained from outside sources at the applicant s own initiative and expense. Promise Pointe and applicant(s) acknowledge that it is very difficult to live on a limited income. It will be important for the applicant(s) to understand what other services are available in the city that would help offset the cost of everyday living. By signing this document, I attest that I am financially, physically and emotionally fit to live independently as set out above. All information provided is true and accurate. I understand that any inaccuracy or incomplete information provided could cause my application to be rejected. Applicant s Signature Printed Name Date 5
Promise Pointe Application Complete Legal Name Date of Birth First Middle Last Proof of Age document Place of Birth Nickname or other Names Used Social Security # Driver s License/State ID # State of issuance E mail address Cell Phone # Work Phone # Do you currently have a case manager? Yes No Name: Agency: Phone: Name of potential additional Occupant (each occupant must complete their own Relationship Age 6
INCOME Please list all sources of income and expenses. Sources of Income must be verifiable. Please attach copies of documentation (i.e., pay stubs) that will assist us in verifying a stable source of income. Earned Income (Job) $ Unemployment Insurance $ Supplemental Security Insurance (SSI) $ Social Security Disability Insurance (SSDI) $ VA (Service Connected Disability) $ VA (Non-service Connected Disability) $ Private Disability Insurance $ Worker s Compensation $ TANF $ General Assistance $ Social Security Retirement $ Pension/Retirement from job $ Child Support $ Alimony/Spousal Support $ Other: $ Other: $ SNAP (Food Stamps) $ WIC $ TANF Child Care Services $ TANF Transportation Services $ Other TANF-Funded Services $ Section 8, Public Housing or other on-going rental assistance $ Other Source: Temporary Assistance $ TOTAL: $ 7
Expenses Phone $ Car Payment/Insurance/Maintenance $ Food $ Transportation/Gasoline $ Medical (Doctor, prescriptions, etc.) $ Other $ Other $ TOTAL: $ Are you currently covered by health insurance? Yes No If so, which program(s): Medicaid Medicare Map Private Pay VA Medical Services Employer Provided Cobra Are you a victim or survivor of domestic violence? Yes No If so, when? By Whom? Do you have the following End of Life Documents? Check all that apply: Declaration of Guardian Directive to Physicians Durable Power of Attorney HIPAA Release Death Certificate Information Sheet 8
References Please list 3 people who are not family members and can serve as personal references. First Name Relationship City/State/Zip Phone with Area Code ( ) Last Name First Name Relationship City/State/Zip Phone with Area Code ( ) Last Name First Name Relationship City/State/Zip Phone with Area Code ( ) Last Name Do you currently have any outstanding warrants for your arrest Yes No Do you currently have any drug or alcohol addiction issues? Yes No Would you be willing to submit to a drug test? Yes No If yes to any of the above, please explain: 9
Emergency Contacts Please list 3 people to contact in case of an emergency. First Name Last Name Relationship to reference City/State/Zip Email Phone with Area Code ( ) First Name Last Name Relationship to reference City/State/Zip Email Phone with Area Code ( ) First Name Relationship to reference City/State/Zip Last Name Email Phone with Area Code ( ) By signing this application, I guarantee the accuracy and completeness of the information provided. I also give Promise Pointe permission to have a Public Data Search and a criminal background check conducted on me. Applicant s Printed Name: Applicant s Signature: Date: Witness Printed Name: Witness Signature: Date: 10
PROMISE POINTE QUESTIONAIRE 1. Are you at least 18 years of age? 2. Have you ever been convicted of a felony? If so, please explain: 3. Are you currently on probation? 4. Do you own any animals?: Y/N If so, what type and breed?: How much do they weigh?: lbs. If you are an animal owner, you are required to provide all shot records and other relevant paperwork prior to moving in. This application is not complete without the appropriate animal documentation. 5. Are you a registered sex offender? 6. Are you a smoker? 7. Have you had an incident of bed bugs in the last 12 months? 8. Have you ever been arrested and/or convicted of domestic violence? If so, please explain: 11
9. Do you own a car that will be parked on property? Y/N If you answered yes, you are required to show proof that your car s registration is up-to-date. Please note, that vehicles are prohibited from parking on the premises if they are inoperable, have no license plates, no current registration, or no current inspection sticker. This application is not complete without attached proper documentation for any cars you own. 10. Do you need a bus pass? If so, what kind (monthly, daily, etc.)? 11. Do you have health Insurance? Y/N If so, what type of health insurance do you have? If you have health insurance, you are required to attach a copy of your health insurance card. This application is not complete without the proper documentation of health insurance. 12. Any prior military service? Yes No Branch: Veteran Status: Do you have a copy of your DD-214? 12