Pasco Hope Application / Waitlist

Catholic Charities, Diocese of St. Petersburg

Pasco Hope Housing Application

Catholic Charities, Diocese of St. Petersburg wants to provide for all those eligible for service. We alone do not make that determination. We must vet applicants to ensure they meet our funder's requirements below:
1. You must have lost housing due to Hurricane Helene and/or Milton.
2. Your damaged housing must have been located in Pasco County.
3. Prior to intake you must provide proof of the loss and residency by submitting all of the following in the name of the applicant and at the address of the damaged housing:
1. Lease, deed, or mortgage statement.
2. A utility bill.
3. Photographs of the damage.
4. Florida driver's license(s) or other state photo ID(s) for the leaseholder (s), named parties on the deed, or mortgage.
5. Proof of income for all household members.
Submitting this form does not guarantee a successful application or a promise of service. Each application must be reviewed and meet all funder guidelines and housing must be available. Housing is only available when a current resident vacates a unit.

A Case Manager will contact you only if your application indicates you may be eligible for service and when housing becomes available.
Please tell us how you found this application:*

A friendCatholic Charities staffSearching the internetThe United WayOther
Date

MonthDayYear
Date

One or more of your responses eliminate you from our funder's guidelines and you are not eligible for these services.

Please call 2-1-1 for alternate assistance.

Welcome to Catholic Charities, Diocese of St. Petersburg Pasco Hope Housing Application

Catholic Charities, Diocese of St. Petersburg wants to help all who are eligible for service. We alone do not make that determination. We must vet applicants before services can be provided. Please be aware the completion of this application does not ensure services will be provided.

As housing becomes available a case manager will review your application and determine if you may be eligible for service. Even if that determination is made, we must substantiate proof for our funders that each applicant is eligible.

Do not stop seeking service with this application as we cannot assure you that services will be available even if you are eligible as openings are only available when the currently housed move out.

If housing becomes available a Case Manager will contact you if your application indicates you may be eligible for service.

Several agreements require your signature, acknowledgment, and acceptance.
- Electronic Signature Agreement - Document 1.a.
- Rules Governing Vehicles on Agency Property & in the vicinity of Agency Property - Document 2.a.
- Pet agreement - Document 3.a.
- HIPAA NOTICE OF Privacy Practices – Document 4.a.
- Rights & Responsibilities Agreement – Document 5.a.
- Program Rules - Document 6.a.
Please read these carefully. If you disagree with any of the statements, program rules, etc., do not continue with this application and seek services elsewhere by calling 2-1-1.

By completing the following fields and choosing the Accept button, your signature and other information you provide will be applied to these documents. All documents are available for your review and labeled for your reference.

Note that multiple family members housed in the same unit will submit an intake on the same entry.
Catholic Charities, Diocese of St. Petersburg Pasco Hope Housing Application

Catholic Charities, Diocese of St. Petersburg wants to help all who are eligible for service. We alone do not make that determination. We must vet applicants before services can be provided. Please be aware that your completing this application does not ensure services will be provided.

Several agreements require your signature, acknowledgment, and acceptance.
- Electronic Signature Agreement - Open Agreement to review
- Agency HIPAA Agreement - Open agreement to review
Please read these carefully. If you disagree with the statements do not continue with this application and seek services elsewhere by calling 2-1-1.

By completing the following fields and choosing the Accept button, your signature and other information you provide will be applied to these documents. All documents are available for your review at the links above.

DO NOT SUBMIT MULTIPLE APPLICATIONS - SUBMIT ONE APPLICATION PER HOUSEHOLD

Name*

First NameLast Name
Date of birth*

MonthDayYear
Enter your email address where you will receive a confirmation:*
example@example.com
Repeat your email address to make sure we got that right:*
example@example.com
Hmmm. Those email addresses do not match.

Please make sure this is your email address and that both fields match. It is important to use an email address that is yours alone as we may use it to communicate with you and send an acknowledgement of your application.
Do you want to receive a copy of your completed application sent to an email address?*

YesNo
birthdate SF

MonthDayYear
Date
Your age today:
Calculates based on date of birth
Age - days:
Electronic signature agreement*

Yes, I accept. I understand that my signature below will replicate anywhere indicated throughout this application.No, I refuse. I understand this cancels my application.
Signature*

Clear
Use your finger to sign in the box

Are there others in your household seeking housing in the same unit (they will live with you)?

None, or they will be housed independentlySpouse/partner or other family member.
Relationship to you

Spouse/partnerFamily member
Spouse/Partner Name*

First NameLast Name
Spouse/Partner Date of birth*

MonthDayYear
birthdate SF

MonthDayYear
Date
Your age today:
Calculates based on date of birth

Hurricane Damage
Which event led to the primary damage of your home?*

HeleneMiltonBoth
Description of damage*
Do you rent or own the home?*

RentOwn
Have you filed a claim with FEMA?*

YesNo
If no, why not?*
What was the result of the claim?*

Hurricane Damage - continued
Do you have homeowner's insurance?*

YesNo
Deductible $amount
Have you filed a claim with your homeowner's insurance?*

YesNo
Why not?
What was the result of the claim?

Hurricane Damage - continued
Address of property damaged by hurricane (that MUST be in Pasco County)*

Enter the Street Address

Street Address Line 2

Enter the city nameState / Province

Enter the zip code. If unknown enter 00000

Head of Household Employment
What is your current employment status*

Employed full-timeEmployed part-timeUnemployed
Employer name*
Employer phone
Please enter a valid phone number.
Start Date*

MonthDayYear
Date
Position*
Hours worked per week*
Pay rate*
income calculation
Do you have any sources of income?*

YesNo

Enter Monthly Income for ALL Household Members
Earned income (wages/salary)
Alimony/spousal support
Child Support
Disability insurance
General assistance
Pension
Retirement Income From Social Security
SSDI
SSI
TANF
Unemployment insurance
Workers compensation
VA compensation
VA disability
Other income source(s)

Do you receive any Non-Cash Benefits (TANF, WIC, SNAP, etc.)?*

YesNo
TANF childcare services
Enter MONTHLY $amount if received
TANF transportation services
Enter MONTHLY $amount if received
Other TANF
Enter MONTHLY $amount if received
SNAP
Enter MONTHLY $amount if received
WIC
Enter MONTHLY $amount if received

Criminal status (skip if none)

Currently on probation or paroleConvicted of a misdemeanorConviction pendingConvicted of a felonySex offenderServed time
Have you been in Jail/Prison In the last 6 months?

YesNo

Disaster Information
Reminder:

Submitting this form does not guarantee a successful application or a promise of service. Each application must be reviewed and meet all funder guidelines and housing must be available. Housing is only available when a current resident vacates a unit.

A Case Manager will contact you only if your application indicates you may be eligible for service and when housing becomes available.
CCDOSP Program
Let's get your photo for your ID card. Please center yourself in front of the camera. Get close enough so that your head and shoulders fill the frame, click Take Photo. You will have a chance to retake it.
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