Welcome to the Homebase Eligibility Screening

This brief questionnaire will help determine if you qualify for Homebase homelessness prevention services.

About Homebase

Homebase helps New Yorkers overcome immediate housing problems that could result in becoming homeless. They can assist with eviction prevention, benefits advocacy, emergency rental assistance, and more.

Do you live within the five boroughs of NYC?

Personal Information

First Name

Last Name

Telephone Number

We'll send updates about your application status

Email Address

Do you have shelter history?

What year did you exit shelter

Are you currently residing in an institution (i.e. prison, hospital, treatment facility) or living on the street or in the shelter?

Have you served in the military? (Army, Reserves, Navy, Marines, Air Force, Coast Guard, Space Force)?

Address Line 1

Address Line 2

City

State

Zipcode

Enter the ZIP code where you currently stay or receive mail

You are outside our service area

You are outside our service area. Please visit the NYC Homebase locations page for assistance.

NYC Homebase Locations

You're in our service area

You're in our service area! Your ZIP code matches with:

Household Composition

How many Adults

Anyone 18 or older in the household

How many children under 18

Any minors under age 18 in the household

Is anyone in the household currently pregnant?

Is anyone in the household 18 or 19 years old and currently enrolled full-time in school?

Is there anyone in the household that is 18 years of age or older enrolled full-time in secondary school or the equivalent level of vocational or technical training school?

How many households that is 18 years of age or older enrolled full-time in secondary school or the equivalent level of vocational or technical training school

Household Income

What is your total monthly household income?

Include all sources of income from all household members

Monthly Income:

Privacy Information

Your information will be kept confidential and used only to determine your eligibility for services. By submitting this form, you confirm that all information provided is accurate to the best of your knowledge.

HELP USA Homebase Program