The Mercer County Housing Initiative was launched by MCBT in Q3 2021 and involves partner agencies from health care to law enforcement, housing providers to social services. The overall mission of this task force is to provide emergency housing, transitional housing and affordable housing for Mercer County residents to help the community thrive and low-income families to increase their potential long-term.

MCBT houses the Mercer County Emergency Housing Fund, which supports area residents who lack stable housing. Please consider making a donation to the fund.

Donate via PayPal

If you are facing housing insecurity or homelessness and are in need of emergency assistance, please fill out the form below. Someone from MCBT or the Mercer County Health Department will be in touch as quickly as possible to assist you.

Mercer County Emergency Housing Intake Form

Date *

YYYY

Name *

First Name

Last Name

Address *

If you do not have a current address, please enter N/A

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How long have you lived at this address? *

Please enter N/A if not applicable

Phone *

(###)

###

####

Please indicate the type of phone # *

Secondary phone

Leave blank if not applicable

(###)

###

####

Please indicate the type of phone # *

Select 'none' if you do not have a secondary phone #

Social Security # *

Date of birth *

YYYY

If you have an email address, please enter it here

HOUSEHOLD INFORMATION

Number of adults in the household *

Who are the adults in the household? *

Select all that apply

Self

Spouse/Partner

Adult children

Other

Number of children under 18 *

Please indicate the ages of the child(ren) *

Please enter 'none' if there are no children under 18 in the household

HOUSING STATUS

What is your current living situation? *

Own home

Rent home

Living with family or friends

Motel/Hotel

Shelter

Living in a place not meant for habitation

If you rent, have you received an eviction or quit or cure notice? *

Are you able to put utilities in your own name? *

What are your housing needs at this time? *

HISTORY

Have you experienced homelessness in the last three years? *

If yes, please indicate the date(s) and place(s)

Are you a veteran? *

Have you been recently discharged from the hospital? *

Have you been recently discharged from jail or prison? *

Do you have any evictions? *

Are you required to live in a certain area? *

HOUSEHOLD INCOME

Do you receive disability income? *

If yes, please indicate who in the household receives disability *

Please enter N/A if this is not applicable

What is the amount of disability income each month? *

Please enter 0 if this is not applicable

Do you have earned income? *

What is the amount? *

Please enter 0 if this is not applicable

Do you receive unemployment? *

What is your total monthly income? *

Please enter 0 if you do not have a monthly income

AGENCY USE ONLY

Please skip this question if you are not an agency filling this out on behalf of an individual

Data Only

Referral

Thank you for submitting your emergency assistance pre-screening form. Someone will be in touch to assist you as soon as possible.

Housing Help Handbook

Facing housing insecurity or homelessness? Help is available. This Housing Help Handbook is a collection of relevant and related resources in one convenient location. Make use of this resource online or download it to your device so it’s always available when you need it most.

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PO Box 73
Aledo, IL 61231

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MERCER COUNTY HOUSING INITIATIVE

Housing Help Handbook

Housing Help Handbook Housing Help Handbook

Housing Help Handbook