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LEAD APPLICANT INFORMATION (Head of Household)
Please complete entirely. Due to the high volume of applications and our shelter's size, not every applicant will receive a call-back.
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Last place you've lived for longer than 6 months and/or where you last paid rent.
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i.e. Male, Female, Non-Binary, Other, N/A...
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Please select all that apply.
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Please include your income and any income received from children.
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HOUSING SITUATION
Please tell us more about your current housing situation and needs.
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SECOND ADULT INFORMATION
Please list information of second adult also seeking assistance...
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i.e. Male, Female, Non-Binary, Transgender, N/A...
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Please select all that apply.
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CHILDREN
Please provide information regarding your children...
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Initials, Age, Gender Identity (i.e. Male, Female, Non-Binary...)
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OTHER HOUSEHOLD INFORMATION
Please provide some additional information to help us provide the best assistance.
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Please list the total amount of your household's income from all sources.
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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.
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How many months of sobriety? (If less than one month, just put "1")
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i.e. "One dog, two cats."
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