HCC Student Intake Form

PLEASE NOTE!

This program is ONLY open to students who have been pre-qualified by the Howard Community College Office of Financial Aid.

If you have not already completed the HCC Office of Financial Aid's Interest/Intent Form for this program, DO NOT COMPLETE THIS INTAKE FORM.

Student eligibility for this program is predetermined by HCC at the beginning of each semester. If you qualify for this program based on your FAFSA/Financial Aid status, you will receive an invitation to apply after the add/drop period for the semester has passed.

Finally, you will receive an email from Columbia Housing Center with a link to this form and the password.

If you are unsure whether you qualify for this program, STOP and contact the Office of Financial Aid before proceeding.
Columbia Housing Center - HCC Student Intake Form
Student Name

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Phone Number To Reach You
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Best Time to Contact You
How many adults reside in your household?
Include yourself in this number
How many children (under age 18) reside in your household?
Household Size (this field is calculated for you - do not edit)
Annual Total Combined Household Income (before taxes)
Please include all income sources for all adult members of the household, including child support/alimony, if applicable.
Are you a female head of household (the member of the family who has been designated by the family as the head for purposes of determining income eligibility and rent)?
Monthly Income
Maximum Monthly Rental Budget (30% of monthly income)
This field is calculated automatically.

Racial Identity: Please indicate the number of people living in the household (including children) that correspond with the following races/ethnicities. This information is required by Howard County DHCD as a condition of the funding we have been granted for rent subsidies.

Rows	Number in Household	Of Hispanic Ethnicity
White: A person having origins in any of the original people of Europe, the Middle East, or North Africa
Black / African America: A person having origins in any of the black racial groups of Africa or the Caribbean
Asian: A person with origins in any of the peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example: Afghanistan, Bangladesh, Cambodia, China, India, Japan, Korea, Laos, Malaysia, Mongolia, Pakistan, Philippine Islands, Thailand, and Vietnam
American Indian / Alaskan Native: A person having origins in North, Central or South America who maintains a tribal community attachment (not just claim of ancestry)
Native Hawaiian / Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands
American Indian or Alaska Native AND White
Asian AND White
Black / African American AND White
American Indian / Alaska Native AND Black / African American
Other/not listed

Do you currently rent an apartment?

Do you need help finding rental housing?
Are you currently experiencing homelessness or are you at risk of becoming homeless in the near future?

How much do you currently pay for your monthly rent?
What is the term of your current lease?

Other
When does your current lease expire?

You're almost done! Please read and acknowledge the statements below, then sign and submit! You will receive a confirmation email and someone from our office will follow up with you very soon to discuss your eligibility for this program.
I understand and agree to the following:
I affirm that all the information submitted in this application is true and accurate to the best of my knowledge.
Should be Empty:

PLEASE NOTE!

This program is ONLY open to students who have been pre-qualified by the Howard Community College Office of Financial Aid.

If you have not already completed the HCC Office of Financial Aid's Interest/Intent Form for this program, DO NOT COMPLETE THIS INTAKE FORM.

Columbia Housing Center - HCC Student Intake Form