You are here: Home / Programs / Forms / Online Housing Application Form

Online Housing Application Form

*HUD Definition

This Agency participates in Wisconsin Service Point.  The information you provide to this Agency will be shared with other area agencies that participate in Service Point unless you request that your information remain confidential and be only available to case workers and intake workers within this Agency.  The collection and use of all personal information is guided by strict standards of confidentiality.

 

 

Do you reside in Calumet, Winnebago or Outagamie County?
If you are not a resident of Outagamie, Calumet or Winnebago County, you are not eligible for our program
Last Name
First Name
Middle Initial
Date of Birth
Phone Number
Soc. Sec. #
Street Address
Apt #
City
How long have you lived at this address?
Employer
Date started
Hourly Wage
Hours per week
Total Monthly Income? $
Have you stayed at COTS before?
If yes, when?
Are you a Veteran?
Are You On Probation/Parole?
Agent's Name (Probation/Parole)
Agent's Phone
Reference #1 Name
Reference #1 Relation
Reference #1 Phone
Reference #1 Address
Reference #2 Name
Reference #2 Relation
Reference #2 Phone
Reference #2 Address
Reference #3 Name
Reference #3 Relation
Reference #3 Phone
Reference #3 Address