LANDLORD PARTICIPATION INTEREST FORM

Landlord Contact Information

First Name

Last Name

Landlord Phone

Landlord Email Address

Rental Property Address

Address Line 1

Address Line 2

City

State/Province

Postal Code

Number of Units Willing to Rent

Unit 1 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 2 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 3 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 4 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 5 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 6 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Add 2nd property?

Yes

2nd Rental Property Address

Address Line 1

Address Line 2

City

State/Province

Postal Code

Number of Units Willing to Rent

Unit 1 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 2 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 3 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 4 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 5 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 6 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Add 3rd property?

Yes

3rd Rental Property Address

Address Line 1

Address Line 2

City

State/Province

Postal Code

Number of Units Willing to Rent

Unit 1 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 2 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 3 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 4 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 5 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Unit 6 Characteristics

Unit #

Preferred Rental Time-frame

Number of Bedrooms

Number of Bathrooms

Interest and Participation

Are you (landlord) interested in the county incentive program?

Are you (landlord) currently participating in any HUD housing programs (e.g. section 8)?

Would you like to receive information on other available opportunities to house people experiencing homelessness?

How did you hear about this program?

What agency?

If other, enter source of information here

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2-1-1 Staff Only: Enter Master InContact ID

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Contact Information