First Name

Last Name

Primary Email

If you do not have an email address, you may enter housinginfo@sageusa.org, but please be sure to enter a phone number, as we need to be able to contact you with more information.

Primary Phone

Date of Birth

Must be at least 18 years old to request more information

You must be 62+ at the time of application. But tell us if you are interested NOW even if you are still 61!

Military Service: Were you ever in service for any branch of the U.S. military?Check if True

Do you have a current mailing address?

YesNo

Mailing Address

Street Address

Apt.

City

Borough

State

Postal Code

Do you currently have a rental subsidy?

If Other, what?

Who are you interested in housing for?

Just meMyself and another personMyself and two other people

Name of other person

Each of these developments has a cap on the amount of income you can earn.

Please note that your annual income is calculated by adding together any money you earn for the year from:

A full time job

A part time job

Owning your own business

Worker's compensation

Payments from investments and retirement

Government assistance like Social Security and Public Assistance

Individual Income

My total income is $37,350 per year or LESSMy income is $37,351 per year or MORE

Monthly Individual Income

To calculate monthly individual income, take your annual individual income and divide it by 12.

Household Income (two people)

Our household income is $42,700 per year or LESSOur household income is $42,701 per year or MORE

Monthly Household Income (two people)

To calculate monthly household income, take your annual household income and divide it by 12.

Household Income (three people)

Our household income is $48,000 per year or LESSOur household income is $48,001 per year or MORE

Monthly Household Income (three people)

To calculate monthly household income, take your annual household income and divide it by 12.

Optional Demographic Information

Sexual Orientation - How do you identify?

Gender Identity - How do you identify?

Race - How do you identify?

Did someone else (besides the elder interested in learning about housing) complete this questionnaire?

YesNo

What is your relationship to this interested elder

FamilyFriendCase worker/social workerOther

Would you like to provide any additional contact information or background on the interested elder?

How did you hear about SAGE's LGBT elder housing developments?

SAGE involvement

SAGE NYC Housing

Lead Source

Status

Responded

Housing Preference

General Housing Interest