Housing Assistance Contact Form

Housing Assistance Contact Form

Please complete the information below to help us understand your housing needs. Items with a red * will need to be entered before submitting. Once received, a UCAP staff person will contact you to set up an appointment to meet and complete an application. If you need immediate assistance after hours, holidays, or weekends, please call our Housing Crisis Line at (507) 537-1416. If you prefer not to use this contact form, please feel free to call a UCAP office in your area.
County of Residence*
Name*

First NameLast Name
Address*

Street Address (if homeless, type "homeless")

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your preferred method of contact?*

Phone callEmail
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
What is your Date of Birth?*

MonthDayYear
Date
Are you a Veteran?*

YesNo
How many people are in your household?*
Check if any of the following apply to you:

I am under 25 years oldI have a disabilityI'm a family with childrenI am fleeing domestic violenceNone of the above
What is your work status?*

Full TimePart TimeMigrant WorkerUnemployed less than 6 monthsUnemployed more than 6 monthsNot in labor forceRetired
How much money does your family make each month?
What is your housing status?*

RenterOwnHomelessOther, please explain:
What is your housing situation?*

I am homelessI am staying temporarily with family or friendsI received an eviction notice or notice to vacateI am behind on my rentI am behind on my mortgageOther, please explain:
How much money do you owe your landlord or mortgage company?
How much is your monthly rent or mortgage?
Is there anything else you want UCAP staff to know?*
Should be Empty: