FHSP: Brilliant Corners Interest Form
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ICMS Information:
Agency Name:
Case Manager Name:
Case Manager Email Address:
Case Manager Phone Number
Client Information:
Participant Name:
CHAMP ID:
Date of Birth
Has the client already submitted an FHSP application?
Yes
No
Is this a Federal Voucher Client?
Yes
No
What type of federal voucher?
HACLA
LACDA-EHV
LACDA-COC
Housing Status
Is this client currently housed in a Brilliant Corner's unit?
Yes
No
Is this client requesting to relocate?
Yes
No
Who is the client's housing coordinator?
Property Details:
Which property site(s) is the participant interested in?
Berendo Tower
Ford Apartments
Residency at the Mayer
Choose your preferred Unit Size for Berendo Tower.
1 Bedroom
2 Bedroom
Does the client require an ADA unit?
Yes
No
What kind of ADA unit does the client need?
Audio/Visual
Mobility
Does the client have a pet?
Yes
No
Is the pet a service animal or an emotional support animal?
Yes
No
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