Thursday, December 1, 2022

Central Valley Housing Application

Please answer the following questions completely and accurately to see if you might qualify for
assistance.
 
ATTENTION
Central Valley Housing does not have apartments
or houses available for rent.
 
Central Valley Housing offers assistance so qualified households can move into permanent housing,
but does not have its own apartments or houses for clients to move into.
Central Valley Housing programs are generally limited to individuals and families living in homeless
shelters or in places not meant to be lived in (cars, tents, etc.). Households need to be able to find their
own place to live; assistance is time-limited and based on income.
Eligibility depends on your living situation, your income, and other factors as determined by federal and
state law.
 
By continuing these questions, I agree that I understand the above statements.
 

Residency I am currently living in San Joaquin County.

*By checking that I currently live in San Joaquin County, I certify under penalty that I am in fact living in San Joaquin County. I am aware that
providing false information may lead to denial of services.

Have you been impacted by COVID-19 Yes

in any of the following ways?

ATTENTION: By clicking "yes", I certify that COVID-19 impacted me or my household in at least one of
the following ways:
- Income loss related to COVID-19 (laid off, reduction of work hours, loss of work hours, place of
employment closed, subsidy has been reduced because of COVID, etc.);
- COVID-19 has prevented me/my household from finding employment/housing;
- I have been unable to find housing because of concerns related to COVID-19;
- I or a household member has been diagnosed with COVID-19;
- I or a household member have been indentified as at high-risk of COVID-19;
- I or a household member has left a job to care for someone who is at risk of COVID or who has had
COVID;
- My household has experienced a child care cost increase or must stay home to care for children;
- My household will be forced to move into an overcrowded situation with another household if we lose
housing;
- My household will be forced to enter an emergency shelter or other congregate facility if we lose
housing;
For more COVID-19 resources, visit the State of California COVID-19 website at https://covid19.ca.gov/

What best describes where you are Car

living right now? Choose the best
answer.

By clicking any of these answers, I certify that the answer accurately reflects my current living
situation. I also certify that I understand misrepresentation of my current living situation may result in
me being ineligible for services or support.
1
How long have you been in the living Longer than one year
situation you described in the
previous question?

The following best describes me and Escaping domestic violence or abuse

my household

Please provide the information requested below so we can best serve you.

Name Angelina Isaacs

Email angelinaandrobert@gmail.com

Phone Number (209) 442-3122

Date of Birth Saturday, February 1, 1986

Social Security Number 555932138

Number of people in your household 1

Monthly Income 0

By checking the box, you agree to the I agree to the

following: CVLIHC collects personal Privacy
information only when appropriate. Statement
We may use or disclose your
information to provide you with
services, including the sharing or
disclosure of information to other
service providers that we reasonably
believe may be able to assist you. We
may also use or disclose your
information to comply with legal and
other obligations. We assume that you
agree to allow us to collect
information and to use or disclose it
as described in this notice. Any uses
or disclosures not described in our
Privacy Policy require your
permission. You can inspect personal
information about you that we
maintain. You can also ask us to
correct inaccurate or incomplete
information. You can ask us about our
Privacy Policy or practices. We
respond to questions and complaints.
You may read the full Privacy Policy
for further details about CVLIHC’s
ability to share a client’s personal
information. We reserve the right to
amend this policy at any time. Anyone
can have a copy of the full notice at
any time upon request.
2
Optional Questions

Race (check all that apply) Refuse to answer

Disabled No

Military Veteran No

Please upload any documents that you have (PDFs, Word docs, high-resolution pictures, etc.)

ID

Thank you for your responses. Please click to submit your application.

NOTICE:
Central Valley Housing cannot provide assistance to people living outside San Joaquin County.
Central Valley Housing does not provide help to those who wish to move to San Joaquin County, or
those who are relocating to be closer to friends, family, or employment.