Housing Resource | Restorationhope

Transitional Housing Application

We are only accepting emergency placement applications at this time.

Who Is the Applicant for

Self

Referral

** If Referral please provide the name of the referring agency or person and the contact phone number

Name of Applicant

First and Last Name

Birthday of Applicant

Month

Day

Year

** Does the applicant have any children?

Yes

** If Yes, what are the age(s) of the child(ren)?

Date the applicant is needing placement?

If immediate placement is not available do you wish to be place on the waiting list?

Yes

I certify that the applicant has never been convicted, pleaded guilty to, or pleaded no contest to any crime or charges involving the physical, sexual, or emotional abuse of a child or person; or any other crimes involving a threat to the health, safety, or welfare of a child.

By hitting submit confirms my agreement to a background check:

Please provide any additional information for our consideration;

I understand this facility only provides transitional housing and mentorship to youth ages 15-26

Documents

Resident Dress Code

Transitional Housing Application

We are only accepting emergency placement applications at this time.

I understand this facility only provides transitional housing and mentorship to youth ages 15-26*

Documents

I understand this facility only provides transitional housing and mentorship to youth ages 15-26