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{jb_quote}"I am so happy to be here. I really feel safe here. Safer than any place I have ever lived."{/jb_quote} {jb_author}Nancy, resident since 2007{/jb_author}
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Housing / Interest Form
Housing / Interest Form
For questions about the Los Angeles LGBT Center's senior housing and/or senior services, please complete this form and someone will follow up with your inquiry.If you have an urgent question, please call us at 323-869-5830.
Contact Information
First Name
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Last Name
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Age Restriction
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I am 62 years of age or older. Applications can only be accepted from prospective residents age 62 or older.
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Partner/SpouseFirst Name
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Partner/SpouseLast Name
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Street Address
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Street Address 2
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City
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State
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- select state -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip Code
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Contact Telephone
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Email Address
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Confirm Email
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Please add my name to the GLEH email list
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Statistical Information
(The following questions are optional and to be used for demographic purposes only.)
What is your age?
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Do you have a live-in home health care provider?
No
Yes
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Monthly income:
- select an amount -
$0 - $925
$926 - $1,387
$1,388 - $1,850
$1,851 - $2,312
$2,313 - $2,775
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Do you have a Section 8 voucher?
No
Yes
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Number of individuals interested in services/housing?
- select -
1
2
3
4
5 or more
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HIV / AIDS?(optional - relates to certain required housing set-asides)
No
Yes
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Are you interested in any of the following services?
Housing
Caregiver Support
Case/Care Management
Recreational Activities
Food/Nutrition/Pantries
HIV/AIDS Related Services
Mental Health Care/Counseling
Substance Abuse Services
Transgender/LGBT Support Groups
Financial Services/Budgeting
Other
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How did you hear about us?
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Please enter the letters
(*)
Refresh
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By checking this box, you are giving Gay & Lesbian Elder Housing permission to provide the information in this document to local housing and/or social service providers in connection with referral efforts,
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