Housing Application

Let's get you started.

Fill out the form below and our team will follow up with you directly. Take your time — there's no wrong way to answer.

Equal Housing Opportunity: A Better Way Forward LLC complies with the New York State Human Rights Law and the federal Fair Housing Act. We do not discriminate on the basis of race, color, national origin, religion, sex, disability, familial status, age, marital status, military status, sexual orientation, gender identity, or lawful source of income.

Don't fill this out:

Applicant Information

Full Legal Name

Phone Number

Email Address

Ready to Move-In Date

Preferred Area / Part of Town

Source of Income

Check all that apply

SSI SSDI TA (Temporary Assistance) PASS VA Benefits Third Party Private Pay

Case Manager / Referring Organization

Case Manager Name

Organization / Agency

Case Manager Phone

Independent Living

Are you able to live independently?

Yes No

Accessibility & Accommodation Needs Optional

Do you have any mobility, physical, or accessibility needs we should be aware of in order to place you in a safe and suitable home (e.g., stairs, first-floor access)? This is voluntary and is not a basis for denial of housing.

Yes No

If yes, please describe (optional)

Additional Information Optional

Any additional information we need to know to find you the most suitable housing?

Applicant Certification

Please review before submitting.

I certify that the information provided on this application is true and accurate to the best of my knowledge. I understand that providing false information may result in denial of this application.

Type your full name as your signature

A member of our team will follow up with you after reviewing your application.

A Better Way Forward LLC · abetterwayforwardllc.com