complete this form to start the screening process. Completion of this form does not guarantee a shared housing Leasing agreement with VYPR-Realty. This process is used to assess appropriateness and eligibility for placement in the most comfortable setting .

Lease Application Fee Required for Processing

Please note that there is a $35 non-refundable application fee required to process your application. This fee must be submitted after the application is completed but before processing can begin. Please make an online payment only after verifying placement availability. Completing the application in a web browser or other non-compatible programs may result in formatting issues or the loss of entered information.

Payment Instructions:

Payments can be made via Online:
or in person:

Make Online Payment

Name *

First Name

Last Name

Date of birth *

YYYY

Phone

Country

(###)

###

####

Email *

or point of contact email

emergency contact name and number

First Name

Last Name

Phone

Country

(###)

###

####

Next of Kin Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Name of organization that referred you

What area (town, city, county, state) are looking to move to? *

North East

Eastside

Central

Westside

Horizon/Socorro

When are you looking to move-in? *

YYYY

are you willing to relocate to another area (town, city, county, state)? *

yes

how long do you anticipate a need for this type of housing? *

6-12 Months

12-24 months

24-36 months

36 or more

Do you have any pets *

yes

Phone

(###)

###

####

what is your source of income? *

ssi/ssdi

employment

section 8

Veterans benefits

public assistance

other voucher programs

how much do you receive as monthly income or support? *

can you make a security/risk free deposit? *

yes

are you able to perform activities of daily living? *

yes

do you have your identification documents? *

Identification Documents

yes

have you ever lived in a shared housing or congregate living situation? *

yes

do you have an adequate source of food and clothing supplies? *

yes

do you have any other financial obligations that limit your ability to pay rent? (i.e. student loans, child support, debt, etc. *

yes

are you enrolled or willing to enroll in a representative payee program *

yes

do you require any special needs assistance *

yes

do you have a behavior or mental health diagnosis *

yes

are you currently on any medications? *

yes

are you currently under a doctors care? *

yes

do you smoke marijuana? *

yes

do you smoke tobacco? *

yes

are you actively using any mind, mood, behavior altering substance? (i.e. alcohol, cannabis, stimulants, depressants, etc.) *

yes

are you under state/federal probation or parole supervision? *

yes

have you been listed at any time on any local, state, or nationwide sex offender list? *

yes

drug of choice *

if applicable

longest clean time/sobriety time ever achieved? *

if applicable

do you have any pending legal matters? *

yes

do you have any vehicles that require parking space? *

yes

do you have any transportation needs? (getting to/from housing placement) *

yes

are you able to provide any personal and/or professional references? *

yes

Reference #1 *

First Name

Last Name

Phone *

(###)

###

####

Reference #2 *

First Name

Last Name

Phone *

(###)

###

####

Thank you!