Overnight Shelter Application

Overnight Shelter Application

Overnight Shelter
We have ZERO tolerance for drug use, alcohol consumption, and violence. NO pets allowed. NO SMOKING ALLOWED.
Applicant Information
How did you hear about this Shelter?*
Name*
First and Last Name
Driver's License/Identification Number*
Email Address*
RolandNava@ITSHUH.org
Phone Number*

Area CodePhone Number
Reason Shelter Needed*
Date of Desired Stay*

MonthDayYear
Date
Length of Stay*

1-4 days5-7 days
Current or Most Recent Address*

Street Address

Unit Number

CityState / Province

Postal / Zip Code

Emergency Contact

Please list a contact that DOES NOT live with you in case of an emergency
Emergency Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Emergency Contact Address*

Street Address

Unit Number

CityState / Province

Postal / Zip Code

Documents

You will be required to present your documents in person during your initial intake interview: - Driver's License or I.D. - Social Security Cards
Please bring photocopy of current ID/DL for applicant and co-applicant. We will contact you at number listed, after review of application. When called for an interview, you must present your and co-applicant’s ID/DL and social security cards. If you have questions or need assistance completing application, please call 1-888-ITS-HUHM.

I AFFIRM THAT ALL STATEMENTS I HAVE INDICATED HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY MISREPRESENTATION I HAVE MADE CAN CAUSE FOR THE INVALIDATION OF MY APPLICATION.
Name of Applicant*

First NameLast Name
Date Signed by Applicant*

MonthDayYear
Date
Should be Empty:

We have ZERO tolerance for drug use, alcohol consumption, and violence. NO pets allowed. NO SMOKING ALLOWED.