Membership Application

Please complete the following Membership Application Form, submit it, and once we receive it we will review it, and contact you via either email or via phone. Please be patient as we are receiving a high volume of applicants and are processing them as quickly as we can. There is a one (1) time non refundable $25.00 Application Fee due at time of applying.

Complete the Membership Application below, once you submit it, you will be taken to a Donation page, you will need to select the correct membership, if you are Military choose the Military Membership and the Processing Fee as well, add it to the cart and purchase them both. If you are not Military then please choose the Standard Membership and the Processing Fee as well, add it to the cart and purchase them both.

Referral Number:

Your State*

Are You an United States Citizen? (if you answer yes, you will be required to show proof)

Yes

First Name:*

Middle Name

Last name:*

Date of Birth:*

Last four (4) of your Social Security Number:*

Your email:*

Address:*

City:*

State:*

Zip:*

Apt. Number:*

Phone Number:*

What is your monthly income, before taxes?*

Are you a:?*

Tenant

Homeowner

Lender's Name:*

Lender's Address/City/State/Zip:*

Landlord or Property Manager First and Last Name:*

Is this person:*

Landlord/Owner

Property Manager

Property Management Company Name:*

Property Management Office Address or Landlords Address:*

City:*

State:*

Zip:*

Please Explain Other:*

Which County are you located in?:*

Do you receive any of the following, choose all that apply:*

EBT

Gov. Healthcare

Lifeline

None Of The Above

Do you have a copy of your Rental Agreement/Purchase Agreement?:*

Yes

At your current location, How many Bedrooms are there?:*

At your current location, How many Bathrooms are there?:*

How much do you pay per month?:*

If Other Please explain:*

How much are each of your Utilities each month, list each Utility and the amount:*

Do you currently have an issue regarding your landlord or property manager? (This could include anything from needed repairs, you have been given notice, to being evicted):*

Yes

If Other was chosen please explain:*

What date is on the Notice?:*

Please explain in detail your current issue with your landlord or property manager, when it started, what it's about, what have you done to try to resolve it, and where you currently stand with the issue: If there is No Issue Currently please mark N/A*

Have you ever been Evicted?:*

Yes

If Yes, please list dates, what cities, states, counties: (List every time you were evicted)*

Why were you evicted?*

Have you ever been through Foreclosure?*

Yes

If Yes, list dates, what cities, states, counties: (List every time you were foreclosed on)*

Have you been served with a Notice of Foreclosure?*

Yes

N/A

Have you ever been homeless?*

Yes

Are you a United States Citizen?*

Yes

Are you Military?*

Yes

Do you have pets?:*

Yes

If Yes, what kind and how many?: (List all pets and kinds)*

Do you smoke?:*

Yes

Do you drink alcohol?:*

Yes

Have you ever been arrested?:*

Yes

Have you ever been convicted of a crime?:*

Yes

If Yes, was it?:*

A Misdemeanor

A Felony

N/A

Have you ever been convicted of drug possession?: (including marijuana)*

Yes

Do you or have you taken any recreational drugs?: (including marijuana)*

Yes

Have you taken any kind of illegal drugs or substances before?:*

Yes

How many people in your immediate family?:(wife, husband, kids, etc.)*

Do other family members that are NOT immediate family live in the household?: (aunts, uncles, in-laws, etc.)*

Yes

If Yes, how many and who are they in relation to you?:*

Would You Like to Enroll in the "American Dream Program"?*

Yes

Photo/Video/Live Stream Agreement: By submitting this Pre Application, we acknowledge and agree to grant permission for the submission of pictures, video, live stream, or any other relevant media showcasing our current place of habitation. The purpose of providing such visual content is to enable S.A.F.E. to accurately assess the present condition of our location. We understand that this information is vital for the organization to make informed decisions regarding our application. Failing to comply with this requirement will result in an incomplete application, potentially leading to delays or disqualification as a candidate.*

I Agree

I Disagree

Waiting List: Upon submission of this Pre Application for review, we affirm our understanding that our placement on the Waiting List for our specific area is contingent upon the completion of all necessary processes by S.A.F.E. Moreover, we are aware that the duration of our wait can vary depending on the processing time, membership open enrollment and other relevant factors. Hence, we acknowledge that submitting our Pre Application form does not outright guarantee acceptance into the membership program. We understand that S.A.F.E. will review our Pre Application with the utmost diligence and will notify us regarding any updates or the next steps in a timely manner.*

I Agree

I Disagree

Initial Intake Interview Agreement: By submitting this Pre Application, we acknowledge and accept the obligation to undergo an Initial Intake Interview conducted by S.A.F.E. during which we will be required to provide accurate information and discuss our current circumstances. This interview is crucial for verifying the accuracy of the data provided and gaining a comprehensive understanding of our present situation. We recognize that this Intake Interview is a mandatory requirement and failing to comply with this request will result in either delays or potential disqualification from further proceedings. In order to accommodate various circumstances, the Intake Interview can be conducted either in person, via video media, or by phone call ensuring flexibility and convenience for the involved parties.*

I Agree

I Disagree

Home Inspection Agreement: By submitting this Pre Application, we hereby consent to and acknowledge the necessity of a Home Inspection being conducted at our current residence. This Inspection is crucial in documenting the prevailing condition of the location where we currently reside. We fully comprehend that any failure to meet this prerequisite could potentially lead to a delay or disqualification in the processing of our application. We recognize the significance of this inspection as an integral part of the assessment process. It serves as a comprehensive evaluation that helps to collaborate the information provided in our application, the Home Inspection allows for the thorough examination of the property, identifying any potential issues or concerns that may need to be addressed.*

I Agree

I Disagree

Membership Rules: If accepted as a member of our organization, it is imperative to understand and adhere to all rules and regulations governing membership. By accepting our membership offer, you acknowledge that failure to comply with these regulations and policies may result in immediate and permanent removal as a member. We hold our members to the highest standards of integrity and expect them to contribute positively to our community. It is essential to create a safe and inclusive environment for all members and violations of these policies will not be tolerated. We encourage all members to familiarize themselves with the rules and regulations of their memberships. Your commitment to upholding these standards is greatly appreciated and essential to maintaining the reputation and integrity of our organization.*

I Agree

I Disagree

Copy of Current Rental Agreement/Purchase Agreement: By submitting this Pre Application, we hereby acknowledge and agree to provide S.A.F.E. with a copy of our current Rental Agreement/Purchase Agreement. We fully comprehend that this allows S.A.F.E. to thoroughly examine the agreement and determine if it is legally binding, ensuring what is precisely detailed and outlined within its contents. Moreover, we understand that S.A.F.E. will retain a copy of our Rental Agreement/Purchase Agreement on file for reference purposes. It is vital to note that failure to submit the Rental Agreement/Purchase Agreement may result in potential delays or disqualification of our application.*

I Agree

I Disagree

Please Type your first and last name below, to digitally sign this Application and the terms of Agreement.*