Application | My Site

Date and time

Month

Day

Year

Time

HoursMinutes

First name

Last name

Other Names Used

Phone

Phone Type

Safe to Call?

Any special instructions for sending messages, via phone or email? (ie certain words not to use or times of day not to reach out.)

Current Address

Country/Region

Address

City

Zip / Postal code

What is your preferred language?

Are you able to understand (verbal and/or written) English?

How did you hear about our program?

Are you at least 18 years old or a legally emancipated minor?

Do you have a driver's license?

If so, what is your DL or ID #

Are you able to work and/or go to school at least 30 hours a week?

Answering yes to the following questions does not disqualify you from our program.

Have you used drugs in the past?

Have you abused alcohol in the past?

Do you use tobacco products?

Have you ever been convicted of a misdemeanor or felony crime?

If so, how long ago was the most recent?

Do you have any outstanding warrants, tickets, or pending criminal charges against you?

Are you currently on probation?

Have you ever received counseling?

Have you ever been hospitalized for a mental or physical illness?

Have you ever had a psychological evaluation?

If so, what was the outcome?

Who do you feel is a part of your support system?

Please list all who would reside with you in the transitional housing program.

Include all relevant dependents, including those of which you may not currently have custody. Provide gender, age, and any specific needs or accommodations needed. Limited to survivors of domestic, sexual dating violence, or stalking and their dependents.

How do your children feel about the idea of coming into the program?

Is there an active CYFD case involved?

If so, who is caseworker?

Do you have a companion or service animal?

If so, list

Are there any other accommodations we can assist you with or provide to ensure your ability to participate in this program? For example wheelchair accessibility, large print.

Are you currently enrolled in an education program?

Current Living Situation

Are you currently homeless as a result of domestic and/or sexual violence, dating violence, or stalking?

Are you willing to relocate to another community?

Are you currently employed?

If so, where?

Do you have a working vehicle?

Are you in need of a safety plan while your application is being reviewed?

Is there anything else you would like to share with us about your immediate safety concerns?

Please explain your family's current circumstances and your needs.

What would you like to accomplish moving to Sheri's House of Hope?

Please include any other information you feel would be helpful for us, when considering your application: Describe any concerns or questions you have about Transitional Housing, which we can discuss when we meet.

If you are not accepted into our program we can still provide information and referrals to a variety of community resources and services. Please describe any services or support you would like to receive information about?

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