HOPWA/HP Eligibility Form

HOPWA Form

*Disclaimer* This eligibility form is for screening purposes only and does NOT determine your final qualification status. After our review process, you will receive an email or phone call from a Stable Home team member.

Personal Information

Are you considered the head of the household?
Address *
Address
City
State/Province
Zip/Postal

Financial Information

Do you have a lease agreement?
Have you received an eviction notice?
Are you currently employed?

Household Information

Housing:
Number in household other than you:
Are you or anyone in your household a person living with HIV? (Information will be kept confidential)
Are you currently receiving services from Catholic Charities Archdiocese of Galveston-Houston?
If yes, which services are you currently receiving from Catholic Charities Archdiocese of Galveston-Houston?

***Please Note: Receiving an eligibility screening call is not a promise of financial assistance. If this is an emergency, please call 911***

reCAPTCHA