Housing Pre-Screening Application

*Indicates required field

First Name

*Last Name

*Street Address

*City

*State

*ZIP

*Email Address

*Phone:

Date of Birth:

*Which location(s) are you interested in? Please select all that apply.
All countiesAtlantic CountyBergen CountyBurlington CountyCamden CountyCape May CountyCumberland CountyEssex CountyGloucester CountyHudson CountyHunterdon CountyMercer CountyMiddlesex CountyMonmouth CountyMorris CountyOcean CountyPassaic CountySalem CountySomerset CountySussex CountyUnion CountyWarren County

*Do you fall into one of the following qualifying categories as defined by NJHMFA? (See sidebar for details)
YesNo

*Is your health insurance currently through Medicaid or NJ FamilyCare?
YesNo

*What is your total annual household income?
Less than $20,000$20,000 – $39,999$40,000 – $59,999$60,000 – $79,999$80,000 – $99,999$100,000 or more

*Do you require a unit with special features? Check all that apply.
No requirementsMobility impaired UnitVisually impaired UnitHearing impaired Unit

*Do you have a service animal?
YesNo

Is there anything else you'd like us to know? (Optional)

I confirm that the information provided in this application is true and accurate to the best of my knowledge.
*Please select "I confirm" to proceed with your pre-screening application.
I Confirm

Please leave this field empty.