San Francisco City Seal
MOHCD Plus Housing
Application

MOHCD Plus Housing Application

Please see www.sfmohcd.org/plus-housing for a full program description. Questions? Email the Program Coordinator.
IMPORTANT: THIS PROGRAM IS ONLY FOR PEOPLE WHO ARE HIV POSITIVE. YOU MUST BE HIV POSITIVE TO APPLY. IF SELECTED FOR ASSISTANCE YOU WILL BE REQUIRED TO SHOW PROOF OF A POSITIVE HIV STATUS.

Are you under threat of imminent eviction? Plus Housing cannot adequately respond to urgent housing needs. Instead, please contact the AIDS Legal Referral Panel (ALRP) at (415) 701-1100 for urgent legal assistance.

PLEASE NOTE - Plus Housing no longer accepts persons who are homeless; please contact the Department of Homelessness and Supportive Housing instead to schedule an intake with the coordinated entry system. Thank you.

You must be HIV positive to apply. Stop if you are not living with HIV.

About you






Please provide your home address (required), and a phone number and/or email address, otherwise your application won't be processed. If you are in transitional housing, provide the address where you are staying.
Your residential address (cannot be a PO box)




Your mailing address (if different from above - CAN be PO Box)




Your phone and email



(if you have one)


If you provide your email, the system will send you a confirmation that your application was received.
Alternate contact
Who can we contact if we cannot reach you? (optional)



 

Your contact's address




   



Your living situation and needs

Please provide information on your CURRENT living situation.

people
(Don't include unrelated roommates, unless they will be moving with you to a new unit provided by this program.)

$
Dollars only (no cents)


$
Dollars only (no cents)


$
Dollars only (no cents)

Your needs: housing, subsidy, or both


RENTAL SUBSIDY pays a portion of recipient's rent (usually the tenant pays 30% of their income and the subsidy pays the rest). Eligibility criteria and amount of financial assistance vary, but the total monthly rent must fall below allowable maximum rent caps. SUPPORTIVE HOUSING means units in affordable housing buildings throughout San Francisco with a range of on-site services that vary by building site. Eligibility criteria may also vary.

Please answer the following

Your answer to these questions will help us ensure we are meeting our goal to equitably serve San Franciscans.  They will not affect your eligibility for Plus Housing in any way, and your answers are kept strictly confidential.

Race & Ethnicity

Which of the following best describe your race and ethnicity?  Choose as many items as apply from the lists below:
















Language



Gender



Sexual Orientation/Sexual Identity



Veteran Status


Veterans are men and women who have served (even for a short time), but are not currently serving, on active duty in the U.S. Army, Navy, Air Force, Marine Corps, or the Coast Guard, or who served in the U.S. Merchant Marine during World War II. People who served in the National Guard or Reserves are classified as veterans only if they were ever called or ordered to active duty, not counting the 4-6 months for initial training or yearly summer camps. All other civilians are classified as nonveterans.

(Don't include unrelated roommates, unless they will be moving with you to a new unit provided by this program.)

Disability


A person with any one of the following six disability types is considered to have a disability:
- Hearing difficulty: deaf or having serious difficulty hearing
- Vision difficulty: blind or having serious difficulty seeing, even when wearing glasses
- Cognitive difficulty: Because of a physical, mental, or emotional problem, having difficulty remembering, concentrating, or making decisions
- Ambulatory difficulty: Having serious difficulty walking or climbing stairs
- Self-care difficulty: Having difficulty bathing or dressing
- Independent living difficulty: Because of a physical, mental, or emotional problem, having difficulty doing errands alone such as visiting a doctor’s office or shopping



If your application is a top-priority application according to the program criteria, all of the information you provided will be verified to confirm your eligibility for the program, and you will be required to provide additional information, including proof of your POSITIVE HIV status, and income and rent documentation. Confirmed applicants will be referred to a housing case worker for a brief assessment to ensure placement with an appropriate housing resource.  Please note that certain housing resources may have additional eligibility criteria for which you may be required to provide additional information. 
By signing (electronically or in print) below, I hereby agree to provide the information required above when requested, declare that all the information provided is true and accurate to the best of my knowledge, and acknowledge that any false statements will result in the removal of my application from consideration.

In addition, I hereby acknowledge and consent to the San Francisco Mayor’s Office of Housing and Community Development (MOHCD) sharing the information provided in this application form, including personal information, with authorized personnel (only) of MOHCD's Plus Housing partners, and only as needed to process my application. This consent remains in effect until withdrawn in writing by letter to MOHCD.

This application does not guarantee housing or subsidy placement.


Mayor's Office of Housing and Community Development
1 South Van Ness Ave, 5th Floor
San Francisco, CA 94103
(415-701-5500) sf.gov/mohcd