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
*
Please Select
Cottonwood County
Jackson County
Kandiyohi County
Lincoln County
Lyon County
McLeod County
Meeker County
Murray County
Nobles County
Pipestone County
Redwood County
Renville County
Rock County
Name
*
First Name
Last Name
Address
*
Street Address (if homeless, type "homeless")
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your preferred method of contact?
*
Phone call
Email
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
What is your Date of Birth?
*
-
Month
-
Day
Year
Date
Are you a Veteran?
*
Yes
No
How many people are in your household?
*
Check if any of the following apply to you:
I am under 25 years old
I have a disability
I'm a family with children
I am fleeing domestic violence
None of the above
What is your work status?
*
Full Time
Part Time
Migrant Worker
Unemployed less than 6 months
Unemployed more than 6 months
Not in labor force
Retired
How much money does your family make each month?
What is your housing status?
*
Renter
Own
Homeless
Other, please explain:
What is your housing situation?
*
I am homeless
I am staying temporarily with family or friends
I received an eviction notice or notice to vacate
I am behind on my rent
I am behind on my mortgage
Other, 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?
*
Submit
Should be Empty: