Loveland Safelot Parking online Pre-application
Loveland Safelot Parking online Pre-application
Last Name
*
Maximum of
50
characters allowed.
Currently Entered:
0
characters.
First Name
*
Maximum of
30
characters allowed.
Currently Entered:
0
characters.
Middle Initial
Phone
Phone
-
###
-
###
####
Email Address
Date of Birth
Date of Birth
*
/
MM
/
DD
YYYY
Gender:
*
Male
Female
Transgender
Other
Client Pronouns:
*
She/Her/Hers
He/Him/His
They/Them/Theirs
Client doesn't know
Client Prefers not to answer
Other
Race / Ethnicity:
*
White
Hispanic / Latino / e / o
Black, African American, or African
Asian or Asian American
American Indian, Alaska Native, or Indigenous
Native Hawaiian or Pacific Islander
Middle Eastern or North African
Client doesn't know
Client refused
Veteran Status:
*
Yes
No
Are there others staying in vehicle with you?
*
Yes
No
How many?
Are there minors in the vehicle (under 18)?
*
Yes
No
If you qualify for a Loveland SafeLot Parking spot, do you agree to a Background Check?
*
Yes
No
Do you give consent (written and/or verbal) for Loveland Safe Parking to share this information with HMIS?
*
Yes
No
Vehicle Information:
This is the description of your section break.
Make/Model of vehicle:
*
Plate State/#:
*
Do you have current Drivers License?
*
Yes
No
Is your Vehicle registration current?
*
Yes
No
Do you have valid vehicle insurance?
*
Yes
No