Laserfiche WebLink
CATHOLIC <br />CHARITIES <br />6P ORANGE COUNTY <br />Safely Home in Santa Ana <br />Eviction Prevention Program <br />Application (Pate 1 of 2) <br />Name: <br />Address: <br />City: Santa Ana State: CA <br />Phone: Email: <br />Total individuals in the household: <br />Date: <br />Zip: <br />Veterans in the household: <br />Adults: Seniors (62+): Children (over 18): Children (under 18): <br />How long have you been at this address?: years months <br />Have you received rental assistance through the Safely Home in Santa Ana program before <br />through Catholic Charities or The Salvation Army? ❑ Yes ❑ No <br />(If yes, referrals will be provided. If no, continue completing application) <br />Have you been helped by other agencies/organizations? ❑ Yes ❑ No <br />If yes, which ones? <br />How long ago? What type of assistance? <br />Who referred you to CCOC or TSA? <br />Have you ever been homeless? ❑ Yes ❑ No <br />If yes, when? <br />For how long? <br />Employment/Income: <br />Employment Status: ❑ Employed FT ❑ Employed PT ❑ Unemployed <br />Monthly Household Income: (including benefits/aid) <br />❑ Wages/Salaries ❑ Gen. Relief ❑ SSI/SSDI ❑ Child Support ❑ V.A./Retirement <br />❑ Unemployment ❑ Calworlcs ❑ IHSS ❑ CalFresh/Food Stamps <br />❑ Other Income: <br />Monthly Rent: ❑ Section 8 <br />