Family Promise Online Intake Form

 

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 contact our staff.

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

We will be in touch as soon as possible after receiving your message,
usually within 2-3 business days.

 

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. 

Our shelter is at capacity and not accepting waitlist applications at this time. But we may be able to answer your questions regarding shelter in Massachusetts or help direct you toward other family shelter resources.

  • 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.
  •