If you are seeking housing assistance through PCCI, please complete and submit this form. Pending availability (see above), an Intake Coordinator will contact your shortly to complete an eligibility screening.

If you are staying with friends/family, couch-surfing, staying in hotel/motel paid for by anyone other than an agency or charity, staying in an institution (including the Dom) where you have been for more than 90 days, staying in an institution (including the Dom) where you have been for less than 90 days and were not on the streets or in an emergency shelter the night prior to entering the institution, do not use this form. Please use the referral form HERE.

If you are with an agency and wish to refer a veteran for housing assistance, please fill out the form on THIS PAGE.

NOTE: If you do not have a phone or email address, please indicate in the Notes section how we can get in touch with you.