AMAAD Housing Application 
Do you have a valid ID? *
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What is your gender? *
 
Ethnicity *
Race *
 
Would you be comfortable living in a home where Black Gay Men are openly celebrated? *
Do You Currently Pay Rent? *
Have you ever lived in a transitional living facility before? *
Are you a student? *
What is your income source? *
 
In the last 30 days have you used any substances? *
Are you currently or planning on attending any outpatient or mental health therapy? *
Are you currently taking any medications? *
Do you currently have a case manager at any agency? *
Have you ever been convicted of a felony? *
Are you currently on probation or parole? *

Over the past 2 weeks, how often have you been bothered by any of following problems?