Apply for Housing – Alexti Transitional Living

Start your housing request.

Complete the form below for an initial housing review. Submission does not guarantee eligibility or placement. Availability can change at any time.

Please do not submit Social Security numbers, bank information, or detailed medical records through this public form.

Prefer a printable form? Download PDF. Need a housing accommodation? View forms & documents.

Applicant First Name *

Applicant Last Name *

Phone

Date of Birth

Desired Move-In Date

Housing Need *

Preferred Location

Current Housing Situation

Probation / Parole Status

Expected Length of Stay

Employment / Income / Funding Information

Accessibility or Housing Accommodation Needs

How did you hear about Alexti?

Additional Information

Please do not submit Social Security numbers, bank account information, passwords, or detailed medical records through this form.

I consent to be contacted by Alexti Transitional Living regarding this housing request and understand that submission does not guarantee placement. *