Success Starts Here: Connect with Us
Thank you for reaching out to us. At Finally Family Homes, we’re dedicated to connecting young adults ages 18-26 with the resources and support they need to succeed. Please answer a few quick questions below so we can understand your current situation. This confidential form will only take a few minutes.If you have any questions, feel free to reach out at success@finallyfamilyhomes.org or 661-347-8503. We’re here for you! To learn more about us, visit our website https://finallyfamilyhomes.org.
Your Name
*
First Name
Last Name
Email
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best Way to Reach You
Call
Text
Email
Your Date of Birth
*
-
Month
-
Day
Year
Date
What cities do you live, work, or go to school in?
Do you have access to the food that you need?
Yes
No
Do you have access to the clothing and other material goods that you need?
Yes
No
Do you have children?
Yes
No
Do your children have everything that they need?
Yes
No
Do you have all the school supplies you need?
Yes
No
Do you have reliable transportation?
Yes
No
Do you have any physical health challenges that need attention?
Yes
No
Are there any areas related to your mental or emotional well-being where you feel you could use extra support or resources?
Yes
No
Do you currently have housing?
Yes
No
Will your current housing be available for at least the next three months?
Yes
No
Do you feel safe in your current housing?
Yes
No
Do you want help with your housing situation?
Yes
No
Please select all supports you are interested in, regarding housing
Host Homes (moving into a family guest room)
Housing Navigation (help finding a place to live)
Bill & Rental Assistance (help covering bills)
Do you have a budget for yourself?
Yes
No
Do you have the legal documents (ID, driver’s license, social security card, etc) that you need to access education, work and health care?
Yes
No / I could use some assistance
Have you completed high school or received your GED?
Yes
No
Are you happy with your current level of education?
Yes
No
Are you currently enrolled in school (college, university, high school, etc)?
Yes
No
Are you currently employed?
Yes
No
Are you happy with your current level of employment?
Yes
No
Do you need any assistance with legal issues?
Yes
No
Are you new to Finally Family Homes?
Yes
No
Not Sure
How did you find us? (who referred you)
Please tell us more about why you are reaching out for support today
*
Do you have a supportive community connection? Select all that apply:
*
Cultural or Identity-Based Community
Church or Faith Community
Mentorship Program
Recovery or Peer Support Group
School Campus Support (Basic Needs Center, Guardian Scholars, Inspire, EOPS, etc)
Housing Support (Single Mother's Outreach, Family Promise, Bridge to Home, etc)
Not Connected
Other
Anything else you think we should know?
Tell us more about yourself and your situation or anything else you think we should know.
On a scale of 1–5, how stressed do you feel most days (1 = Not stressed, 5 = Extremely stressed)?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
On a scale of 1-5, how confident are you that you can improve your situation on your own (1 = not confident, 5= very confident)?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Submit
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