Are you in need of shelter or services?

Please complete the intake form below.

We receive a high volume of applicants and have very few openings in our shelter.

If you have any questions, please call our office: (978) 922-0787

 

  • LEAD APPLICANT INFORMATION

    Please complete entirely.
  • i.e. Male, Female, Non-Binary, Transgender, N/A...
  • Please select all that apply.
  • SECOND ADULT INFORMATION

    Please list information of second adult also seeking assistance...
  • i.e. Male, Female, Non-Binary, Transgender, N/A...
  • Please select all that apply.
  • CHILDREN

    Please provide information regarding your children...
  • Name, Date of Birth, Gender Identity (i.e. Male, Female, Non-Binary...)
  • i.e. "Briscoe Middle School, Beverly MA."
  • OTHER INFORMATION

    Please provide some additional information to help us provide the best assistance.
  • Please note that our shelter is a low-barrier program. Having a criminal history will not prevent admission to the program. However, failure to answer this question and omission of details could lead to future discharge from the program.
  • How many months of sobriety? (If less than one month, just put "1")
  • i.e. "One dog, two cats."
  •