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Waitlist Application 

CSH Wait List Form 

General Information:
Qualifying Questions:

1. Does someone in the household have a disability?

Select an option

Does the household receive rental assistance?

Select an option

3. Has anyone in the household ever been convicted of manufacturing drug?

Select an option

Been convicted of distribution of hard drugs in the last 10 years?

Select an option

Been convicted of anything violent in the last 3 years?

Select an option

Is anyone in the household on the sex offender registry?

Select an option
Additional Information:

2. We have a preference on our waiting list for people who receive services through Region Ten. Does someone in the household receive Region Ten services?

Select an option

3. How many people are in your household?

Select an option

4. How many bedrooms do you need?

Select an option

5. Do you need to avoid stairs?

Select an option

6. Do you require an accessible unit?

Select an option

Thank you for your interest in Community Services Housing. If you do not hear from us within 3 months, give us a call just before that time and ask for the leasing specialist to extend your time on the list so that we will know that you are interested in remaining on the waiting list. If you do not call us before the 3-month mark, your name will be taken off the waiting list. 

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Thanks 

Community Services Housing, Inc. 

Thanks for submitting!

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