Family Promise Online Intake Form

PLEASE NOTE: All of our programs are at capacity as of 9/14/23.
Families filling out this form after 9/14/23 will be added to our waitlist for a call back as spots open up within our programs.

If your family is in need of Emergency Shelter, Financial Assistance Related to Temporary or Permanent Housing Stability, Eviction Prevention, or any needs related to housing and homelessness prevention, please fill out this form to be added to our waitlist.

If you are a referring agency, please fill out this form instead.

Online Intake Form

Please note that our services are only available for households with at least one child under the age of 18, and who are located in Essex and Northern Middlesex Counties. As mentioned above, as of 9/14/23, all of our programs are at capacity. It may be weeks or months before our staff is able to begin processing families on the waitlist.

Our shelter remains at capacity and is not accepting waitlist applications at this time. If you submit an intake and are in need of shelter, we may be able to answer your questions regarding shelter in Massachusetts or help direct you toward other family shelter resources – however, due to staff capacity, it may still be weeks before we will be in touch.

  • Example: friend, agency (please name)
  • Please check all that apply. Note that unfortunately we cannot typically offer financial assistance for hotel stays.
  • Please help us better understand your situation and what kind of support would be most helpful.
  • Include anyone in your household who is 19 years and above.
  • Providing this information is is optional. You can write "prefer not to answer" if you prefer not to answer. This demographic information will not be used to determine eligibility for services.
  • If pregnant, count as 1 child. If none, write 0.
  • Providing this information is is optional. You can write "prefer not to answer" if you prefer not to answer. Write "0" if there are no children in your household. If someone in your household is pregnant, you can list the due date here. This demographic information will not be used to determine eligibility for services.
  • Include all cash sources like gross wages (before tax), unemployment insurance, cash assistance (DTA), child support, alimony, etc. but do not include food support, WIC, fuel assistance, or other non-cash benefits.
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