About our program
We are not an emergency shelter option, we provide a structured program that assists families with children with shelter at our facility while working on 3 main goals; make money, save money and find housing. Must pass a background check and drug screen to be approved for the program. More information can be found on our website.
Full Name
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Email
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Call Back Number?
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Who referred you or how did you find us?
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Please Select
Project pass/School
211
Church in Irving
Child protective services
Another Family Promise
Google
Social media
Other
What type of assistance are you looking for? At this time, we are not offering Rental/Utility assistance. We also do not provide hotel vouchers. Only continue with this form if you have children under 18 and are seeking a shelter program.
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Please Select
Rental/Utility
Shelter
Do you have Children under 18? We serve families with children, if you do not have children we cannot assist.
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Yes
No
How many children do you have?
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Other Adults in Household?
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Yes
No
Secondary Adults Name
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Relationship status?
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Please Select
Single
Married
Divorced
In a Relationship
Family member
Do you have an Eviction or a Broken lease on your record?
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Yes
No
Eviction date
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/
Month
/
Day
Year
Date
Are you homeless or at risk of being homeless?
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Yes
No
Reason(s) for homelessness
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Where did you sleep last night?
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What city are you currently in?
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Are you experiencing Domestic violence?
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Yes
No
Do you have an open CPS case?
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Yes
No
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Are you employed full time now?
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Y
N
Part time
Who is your Employer?
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How long have you been working there?
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Other adults in household employed full time?
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Y
N
Employer
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How long?
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Last Stable Residence
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Apartment
House
Staying with friends/family
Motel/Hotel
Other
City
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How long?
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Reason for leaving
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Other sources of monthly income?
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Y
N
Amount?
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Do you have any additional government subsidies?
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SNAP (Food stamps)
TANF (Temporary Assistance)
SSI (Social Security Income)
SSD (Disability)
No
Transportation source?
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Own Car
Public Transportation
Friends/Family Drive me
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Next
What is your need? Use this space to tell us your story.
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Submit
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