HPP 2023 Application Form
The Family Promise of Hudson County’s Homelessness Prevention Program 2023 (HPP) is a rental assistance as needed program, in addition to mandatory virtual case-management for the duration of the 2023 calendar year.  

The Family Promise of Hudson County  Homelessness Prevention Program is a program that provides future rental assistance (as needed) along with mandatory, virtual, long-term case management to the families of Hudson County.

This program not only encompasses rental assistance, but also provides families with referrals to other programs that will benefit them for long term success.

In order to be qualified for our program, the family must:

- Must be a resident of Hudson County
- Consist of at least 1 child under the age of 18
- Be current in their monthly rent
- Have a current lease
- Receiving no other rental subsidies
- Received no rental assistance from ANY program within the past 2 years  
- One family member be gainfully employed (Proof of 2 paystubs required)

This application should take about 10 minutes to complete.  
Please ensure answers are formatted as represented, improper answers will affect your process through our program.

Upon submission of your completed application we will reach out to you within 3 business days to schedule a phone interview.

If you have questions about the program or application please email Elena Gurczeski at
e.gurczeski@familypromisehudsoncounty.org
Sign in to Google to save your progress. Learn more
What is the first and last name of the Head of Household? *
First and last name of who is submitting this application. *
What is your email address? *
What is your phone number? *
Best time for contact? (Day & Time) *
Where you referred? If so, by who? (If nonapplicable, put N/A) *
How many adults reside in your household? (18+) *
How many children under the age of 18 reside in your household? *
Please list the names, ages, and gender of everyone in your household. (ex. Mary Smith (17) 6/12/2004) *
If children are school age, list school and grade of each child? (If nonapplicable, put N/A) *
Please list all monthly income amounts and income sources for each family member. *
Do you or anyone else in the household receive any other assistance?                                                           (Please check ALL that apply; if the program is not listed please fill in)
What is the total current monthly income of the Household? (If nonapplicable put N/A) *
Do you have any outstanding debt? (Please select all that apply) *
Required
If you selected any of the previous, please list an estimated amount of each. (If non-application, N/A) *
If you listed any type of debt above, are you current on your payments? *
If you have outstanding debt, about how much in dollar amount? (if not applicable, N/A) *
What is your current address? (Street, Apartment Number, City, State, Zip Code) *
Do you have a current lease? *
When does your current lease expire? *
MM
/
DD
/
YYYY
What is your current monthly rent amount? *
If you receive rental assistance from another program, what dollar amount of your current monthly rent do you pay? (If non-applicable, N/A) *
Are you current on your rent? *
If you are behind in your rent, what is your current balance in dollar amount? (If non-applicable, N/A) *
If you are accepted into our program and receive rental assistance, could you pay your next rental payment when due? *
Are you willing to participate in weekly/bi-weekly, virtual case management while you receive long-term rental assistance from FPHC? *
Have you received assistance from Family Promise of Hudson County in the past? *
Do you have any of the following? (Check all that apply) *
Required
If you have a checking and/or savings account, please list how much you currently have in each. (If non applicable, N/A) *
What is your racial or ethnic identity? (Select all that apply) *
Required
Do you have a history with domestic violence? *
Do you have a history of drug use? *
If yes, please explain.  (If non-applicable, N/A)
Do you believe you and your household would benefit from any of the following?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Family Promise of Hudson County. Report Abuse
Google Forms