Skip to Content

ZN•RK Safe and Secure Housing Program Application

This program is designed to help connect you with safe, stable housing and the support you may need.
Please fill out the form below to help us understand your situation.

Name *

First Name

Last Name

Phone

(###)

###

####

Email *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

First Name

Last Name

Phone

(###)

###

####

Current Housing Situation

What is your current living situation?

(Check one)

Renting

Living with family or friends

Emergency or temporary accommodation

Sleeping rough (no fixed address)

How long have you been in this situation?

(Short answer)

Are you currently connected to any housing services?

Yes

No

If yes, please list:

Housing Needs

What type of housing are you seeking?

(Check all that apply)

Emergency accommodation

Transitional housing

Long-term stable housing

Supported housing (with services)

Do you have any accessibility, health, or family needs that should be considered?

(Short answer)

Preferred Location(s):

(Short answer)

Support Needs

What additional supports would be helpful to you?

(Check all that apply)

Help navigating housing applications

Financial assistance or advice

Mental health support

Employment support

Community connection programs

Other (please specify):

Thank you!

People

•

Pathways

•

Purpose

•

People • Pathways • Purpose •

Location

Unit 2, 2 Mint Street, East Victoria Park 6101

Contact

info@zionark.au
0401 120 995