Home Seeker Application Form

Please fill in the form and then click the "Submit" button at the bottom of the page to send your application to DMCC.  Please note that first name, last name, and email are required.

What kind of rental arrangement do you want?

Straight rental?
Maximum monthly rent you're willing to pay?
< $500  $500  $600  $700  $800  $900  $1000+

Exchange services for part of rent?
Number of hours of services you can provide weekly
Maximum monthly rent you're willing to pay in addition to services?
< $500  $500  $600  $700  $800  $900  $1000+

Exchange 20 hours of services for full rent?

If exchanging services —
What types of services are you able to exchange for rent?
housekeeping
cooking
babysitting
yardwork
companionship
petcare
house sitting
transportation  —> have auto?
Any other services you can offer?

What facilities do you require?
private bathroom
private phone
furnished rooms
laundry room access
garage or parking space
bus nearby
grocery nearby
no-stairs
wheelchair access
Any other facility requirements?

About the housemate you seek:

Prefer a female, male or couple?
female   male   couple   no preference

Do you have an age preference?
under 40   40 - 60   over 60   no preference

Would you consider living in a home with children?
no
yes  —> only young children   only teenagers

Do you object to smoking or drinking?
no smoking   no drinking

Would you consider living in a home with pets?
no
yes  —> no cats   no dogs

About you:

Address:

City: State: Zip:

Phone: day night

Prior Residence:
Address:
City: State: Zip:
County:
Dates: from to

List all people who will live with you (give name, relationship, age):

Do you have a pet?
no
yes  —> Type of pet

Do you smoke or drink?
do not smoke    smoke inside    smoke outside  
do not drink       drink socially     drink at home

Source of income:
Employment Social Security SSI VA Other

Gross annual income:
(Income limitations apply - verification required)

Age: Date of birth:
Male Female

White    Black   Native American
Hispanic   Asian/Pacific Islander

US citizen?
yes 
no  —> Permanent resident? 
yes —> Immigration number 
no —> Visa number 

References:

Previous Landlord:
Name:
Address:
City: State: Zip:
Phone:

Personal Reference:
Name:
Address:
City: State: Zip:
Phone:

Work Reference:
Name:
Address:
City: State: Zip:
Phone:

If you want to start over with a clean form, click "Reset."

If your entries are complete, click "Submit" to send your application to DMCC.

Reminder:  This form will not be sent unless you have filled in the required information at the top of the page (first name, last name, email).