SHARED ROOMS
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(815) 494-4204
815rooms4rent@gmail.com
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About Us
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House Keeping & Laundry Rules
Homelessness
Intake Form to Become a Member
Contact Us
Home
About Us
Become a Member
House Keeping & Laundry Rules
Homelessness
Intake Form to Become a Member
Contact Us
Email:
815rooms4rent@gmail.com
Contact Us
First Name
Last Name
Email:
Phone:
City
State
Last 3 Years of Residency
Current Residency
Criminal Background
Date of Birth
Last 4 Digits Social Security Number
Where you've worked at
Are you currently working?
Yes
No
Monthly Income (current)
Proof of Document
Upload file
Do you have a bank account?
How many years have you been experiencing homelesness?
Are you a veteran?
Yes
No
Do you have any pets?
Yes
No
Interview Date
Interview Time
Upload current photo of yourself
Upload Photo
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