Cuyamaca Cares Housing Intake Form

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By completing this form you are allowing Cuyamaca Cares to connect you to services that are right for you and your individual circumstances. Please complete this form to the best of your ability and a Cuyamaca Cares staff member will contact you. Due to the high volume of students requesting assistance, please allow at least one week for a response. We appreciate your patience.

This housing intake form is for those who are currently experiencing homelessness or are at a high-risk of homelessness (i.e. have been given an eviction notice or have been informed that you will be receiving one).

If you are looking for affordable housing but currently live in stable housing, please check out the County of San Diego's affordable housing website here: https://www.sandiegocounty.gov/content/dam/sdc/sdhcd/docs/rental-assistance/housing-resource-2020-rev.pdf

Email *

Phone Number *

First Name *

Last Name *

Student ID Number *

Age *

How many adults in your household? Including yourself. (if you are experiencing homelessness, how many adults are with you? *

Number of children under 18 (if none, please enter N/A) *

Are you a single parent? *

Yes

Are you or your child currently on Cash Aid? *

Yes

I don't have children

Are you currently experiencing homelessness? *

Yes

If no, have you recently been served an eviction notice? *

Yes

N/A

Please describe your current living situation (i.e. with friend or family member, couch surfing, in shelter, etc.) *

Are you living in your car? *

Yes

How long have you been living in this situation? *

If you are experiencing homelessness, what brought on this situation? (if you are not experiencing homelessness, please enter N/A) *

Current city (does not have to be an address, just the city you currently reside in) *

Are you employed? *

Yes

Monthly income, please add all income: employment, SSI, disability, VA compensation, unemployment, TANF, GR, child support, etc. (your answer will not impact Cuyamaca Cares' ability to assist you) *

Are you interested in employment assistance? *

Yes

Did you complete the FAFSA for this academic year? *

Yes

If you did not complete the FAFSA for this academic year, please state why not. (if this does not apply, please enter N/A) *

Are you receiving financial aid? (your answer will not impact Cuyamaca Cares' ability to assist you) *

Yes

I did not apply

I was not awarded

Are you currently receiving CalFresh/EBT? *

Yes

Are you currently receiving any of the following social services? *

General Relief

CalWORKs

SSI

TANF

None

Required

Are you an active member of any of the following Cuyamaca College services? *

EOPS

NextUP!

UP!

C.A.R.E. (for single parents)

CalWORKs

Rising Scholars

Veteran Services

RISE

None

Required

Were you in foster care either on or after your 13th birthday? *

Yes

Are you a veteran of the US Armed Forces? *

Yes

Are you planning on transferring to a university after Cuyamaca? *

Yes

If yes, where are you planning to transfer? (If you are not planning on transferring, please enter N/A) *

Please describe what housing services you are hoping to obtain *

A copy of your responses will be emailed to the address you provided.

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