Due to the generosity of our supporters, A Shelter for Cancer Families (ASCF) is able to offer no-cost housing to cancer patients and their family members (“Tenant”) seeking treatment, follow-up or second opinions in the Houston area. ASCF is dedicated to helping as many people as possible and in order to do so, we need to ensure the general condition of the apartment, as well as the furniture and other items contained within the apartment remain in good condition during a Tenant’s stay.

Within 24 hours of moving into the temporary housing made available to the Tenant through the ASCF Apartment Program, a thorough review of the inventory in the assigned apartment must be completed, noting the presence and condition of each item listed on this form.

The Tenant is required to complete and submit this form within 48 hours of arrival.  Please scroll-down to submit electronically.  If you would prefer to complete a hardcopy, please visit our office at 4115 Drake Suite 4.  
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A general review of the condition of the apartment and an inventory of all items will be conducted after the Tenant has vacated the unit. Damaged property, and/or missing or damaged items (including keys and FOB), will result in a forfeiture of the Tenant’s deposit, and additional charges may be incurred as required to replace or repair the item(s). For this reason, it will be necessary for the Tenant to provide credit card information, held for the possibility of these incidental charges. Additionally, failure to maintain the general condition of the apartment and its contents and/or to return all items (including keys and FOB) may result in Tenant’s inability to utilize future housing services through the A Shelter for Cancer Families.

Property Address:

4115 Drake Street, Houston, TX. 77005

​Please provide condition of each:

​Kitchen Items: