Eviction Prevention Assistance June 2026 Hope In Keys Services Intake Form

🏡 About The Prevention Connection

A Program of N.O.A.H.'s Foundation Inc. (NFDN)

The Prevention Connection helps individuals and families who are at risk of losing their housing remain safely housed through short term financial assistance and housing stabilization services.

Eligible participants may receive assistance with past due rent, utilities, security deposits, or other approved housing related expenses based on program guidelines and available funding. Financial assistance is paired with case management to help participants resolve their immediate housing challenges and develop a plan for ongoing housing stability.

The Prevention Connection is a short term assistance program. Participants are expected to actively participate in case management, communicate with program staff, and work toward maintaining stable housing after program assistance ends.

Our goal is simple: to help households resolve a housing crisis, remain in permanent housing, and connect them with resources that support long term stability.

📋 Before You Begin
The next section of this application will ask questions about your current housing situation, your risk of eviction or housing loss, your household, income, and the financial assistance you are requesting through The Prevention Connection.

Please answer every question honestly and upload all requested documents to the best of your ability.

If you do not have every required document today, you may still submit your application with the documents you have available. However, all required documents must be received by July 30, 2026, for your application to be considered complete.

Providing complete and accurate information helps us determine your eligibility and process your homelessness prevention application as quickly as possible.

Please verify your email to begin this application.* This field is required.

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Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

Name* This field is required.

First Name

Last Name

Phone Number* This field is required.If you do not have a phone number, put zeros in the boxes.

Area Code

Phone Number

Please tell us your communication preference. It is not guaranteed but we will do our best to honor it.* This field is required.

What is your date of birth?* This field is required.

Date

What is your gender?* This field is required.

Please describe your household. ONLY SELECT ONE.* This field is required.

SINGLE INDIVIDUAL, NO KIDS

COUPLE, NO KID(S)

SINGLE PARENT, WITH KID(S)

OTHER

TWO PARENTS, WITH KID(S)

What is your highest education level?* This field is required.

High Diploma/GED

Bachelors Degree or Higher

AA Degree

Certificate or Trade

Some college

Did not complete any of the above

Do you have any children that will be added to your case?* This field is required.If they live in your household they must be added.

YESNO

If you answered yes, please tell us how many children you have.* This field is required.

Race and Ethnicity. Check All that apply.* This field is required.

Black, African American, or African

Hispanic, Latina/o

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Other

Are you apart of any tribes?* This field is required.

U.S. Federally Recognized Tribes

First Nations Tribes

State Recognized Tribes

Latin American Tribes

Other Tribal Affiliation

None of thee above

Not applicable

I decline to share

Prevention Verification* This field is required.Please select what best describes your situation.

I have received a 3 Day Notice to Pay Rent or Quit.

I have received a Notice to Vacate, Notice of Lease Termination, or another eviction notice.

I am behind on my rent and unable to pay, but I have not yet received an eviction notice.

My landlord has informed me that I may lose my housing because of unpaid rent or lease violations.

I am at risk of losing my housing because of a temporary financial hardship, such as loss of income, reduced work hours, or an unexpected emergency.

My previous rental assistance has ended, and I am unable to maintain my housing without short term assistance. I was enrolled into another program and they stopped paying.

My landlord has started an eviction.

Other

How much is your rent?

Please enter the ZIP Code where you are currently living.* This field is required.

Are you being more than six months of rent?* This field is required.

YESNO

Have you informed your landlord you are applying for rental assistance?

YESNO

What is causing your housing crisis?* This field is required.

Loss of employment

Domestic violence

Reduced work hours

Increase in rent

Medical emergency

Utility costs

Unexpected expenses

Other

Death in household

Does the person completing this form or anyone in this household have a disability?* This field is required.

YESNO

Are you employed?* This field is required.THIS PROGRAM REQUIRES STABLE INCOME TO PAY RENT. WITHOUT STABLE INCOME, YOUR APPLICATION MAY BE DENIED.

Yes, full time

Yes, part time

No, but I am willing to accept full time work.

No, I am unable to work.

What is your primary source of income? Please check all that apply.* This field is required.

Employed Full Time

Employed Part Time

Cal Works / Cash Aid

General Relief (GR)

Cal Fresh

Social Security / Pension

Disability Benefits

Unemployment

Child Support / Alimony

In person appointments will be required. Please select the option that best describes your current transportation status. In person appointments are required once a month.We will always do our best to meet you where your need is. In most cases, we come to you.* This field is required.

I have a vehicle or access to one

Rideshare (Uber/ Lyft)

Walking/ Bike/ Scooter/ etc,

Child Support / Alimony

No Transportation

A family member or friend will drive me

Other

Have you been incarcerated?

YESNO

Are you a veteran?* This field is required.

Yes

I decline to share

Are you a victim of domestic violence? Disclaimer: selecting yes does not expedite this application. Applications are processed in the order they are received.* This field is required.

Yes

I decline to share

Do you struggle with substance abuse?* This field is required.

Yes

I decline to share

Please upload the following documents to complete your file. If you are missing documents that is okay, but please upload as many as you can to expedite your case.

Identification (valid photo ID)
Birth certificates for children and minors
Social Security card 18 and over only
Lease agreement (if applicable)
Eviction notice (if applicable)
Proof of income and recent pay stubs
Any additional documents or information you believe may help support your case

Once these documents are received, our team will review them and follow up with the next steps in your eligibility process.

Please upload the following documents to complete your file. If you are missing documents that is okay, but please upload as many as you can to expedite your case. The more documentation you provide, the faster your application can began processing. Please upload as many as you have.Identification- Social- Birth Certificates- Proof of Income-- Eviction Notice- Lease Agreement-Other

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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We require additional information to complete your intake and provide the best assistance. Please share more about your situation or circumstances.* This field is required.

How did you hear about us?

Instagram

Facebook

A family member or friend

The Source LA

Chirp LA

SBRBN

Council District 8

Council District 10

Do Good Daniels Foundation

The Change Reaction

City of Gardena

City of Torrance

Walk IN

Phone or Email

Other

Type a question* This field is required.

I authorize the N.O.A.H's Foundation Inc. to receive my information and I certify all information is true.

I agree to Privacy Policy and Terms of Use.

I understand submission does not guarantee assistance.

I understand funding is subject to eligibility and availability.

Eviction Prevention Assistance June 2026 Hope In Keys Services Intake Form