Residence Application

If you are interested in our services, please complete the following form.

Do you receive any Income?
Are you employed?
Are you also employed elsewhere?
Do you receive Social Security and/or Disability?
Do you have a pending application for Social Security and/or Disability?
Do you receive Unemployment Benefits?
Do you receive SAGA / Cash Assistance?
Are you able to pay rent?
Have you ever utilized Basic Needs Services?
Are you on probation or parole?
Do you have any pending legal cases?
Do you have any warrants for your arrest?

* Please note that in order to receive basic needs housing, clients must attend 12 Step Meetings and be engaged into IOP, OP and/or One to One Therapy