Jones Haven for Women Interest Form

Jones Haven for Women Interest Form

Application for Single Adult Women Seeking Shared Independent Housing
Jones Haven for Women – Program Overview

Jones Haven for Women is a shared, independent-living housing program for single adult women only. This program is designed to support women who are seeking a safe and stable living environment while working toward greater housing stability. The housing model is structured, community-based, and focused on personal responsibility and independence.

This program serves adult women without children. Jones Haven for Women is not a shelter, childcare program, medical facility, or assisted living environment. There is no on-site staff, supervision, or supportive services provided. All participants must be able to live independently, manage their own daily responsibilities, and participate in a shared living environment with other women.

Housing is provided in a shared-home setting with furnished bedrooms and shared common areas such as the kitchen, living room, bathrooms, and laundry. Placement is based on program fit, availability, and the ability to meet shared living expectations and financial obligations. This is intended to be transitional housing, not permanent housing.

Important Notice
This application is used to assess program fit and eligibility for shared, independent-living housing for single adult women. Submission of this application does not guarantee housing placement.

Income Requirement & Verification
All participants must have verifiable income in order to be considered for placement. Income may include employment, SSI/SSDI, benefits, or approved third-party support.

Income must be verified prior to move-in. Acceptable verification may include recent pay stubs, benefit award letters, or official documentation from a sponsoring agency.

⚠️ If you do not currently have income, you may still complete this application. However, you must have a clear plan to obtain income or secure a third-party sponsor prior to being approved for housing.
IMPORTANT NOTICE – PLEASE READ BEFORE APPLYING
Jones Haven for Women serves single adult women only. Children are not permitted in this program.

If you are applying for housing for yourself and a child or children, do not continue this application. Please stop now and complete the Jones Haven for Women & Children application using the link below:

👉 https://form.jotform.com/260314691869062

Applications submitted for Jones Haven for Women that include children will not be processed.
SECTION 1: APPLICANT INFORMATION
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
DOB*

MonthDayYear
Date
Email*
example@example.com
Emergency Contact - Full Name
Emergency Contact - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SECTION 2: HOUSING NEED & RELOCATION
Jones Haven for Women is located in Elkton, Maryland. Are you able to relocate to Elkton, Maryland?*

YesNoN/A
Desired Move-In Timeline*

ImmediatelyWithin 30 days30–60 daysJust exploring
Reason for Seeking Housing*

Transition / StabilityLeaving unsafe environmentFinancial resetOther
SECTION 3: CURRENT HOUSING STATUS
What is your current housing situation?(Check all that apply)*

Staying with family/friendsTransitional or temporary housingHomeless or at risk of homelessnessCurrently rentingShelterHotelOther
SECTION 4: INCOME & PAYMENT PATHWAY
Do you currently have a source of income?*

Employed (full-time or part-time)Receiving benefits (SSI, SSDI, TANF, child support, etc.)Both employment and benefitsSupport from a third party (case manager, agency, family member)No current income
Is your employment remote/transferable to MD?*

YesNoN/A
Employer Name (N/A if not applicable)
Are you seeking third-party payment support?*

YesNoN/A
Are you able to contribute toward monthly program costs at this time?*

YesNoWith assistance from a third party
SECTION 5: PROGRAM FIT & EXPECTATIONS
Have you ever been convicted of a felony?*

YesNo
Are you currently on probation, parole, or any form of supervised release?*

YesNo
Are you currently required to register under any state or federal registry?*

YesNo
Jones Haven for Women serves single adult women only. Children are not permitted in this program. Please confirm that you are applying for housing for yourself only.*

Myself only
What kind of housing support would best fit your needs?*

Independent shared livingShort-term transitional housingLonger-term supportive housingJust gathering information
Would you be open to connecting with support services (employment, counseling, education, etc.)?*

YesNoMaybe
Jones Haven for Women is a shared housing program, not individual or private housing. Are you comfortable with a shared living environment?*

YesNoUnsure
Are you able to follow program rules, house expectations, and participate respectfully in a shared community?*

YesNo
If applying with children, please list each child’s age.(If you have no children, please enter N/A or 0.)
Will all children be living with you full-time?

YesNoShared custody / part-timeDoes not apply
Do you have a case manager or service provider supporting you?*

YesNo
Name of Case Manager or Service Provider (N/A if not applicable)
Email of Case Manager or Service Provider (N/A if not applicable)
example@example.com
SECTION 6: ACKNOWLEDGEMENTS
How did you hear about Jones Haven for Women?*
Would you like to receive updates when housing becomes available?*

YesNo
Please share anything else you believe is important for us to know when reviewing your application:
Should be Empty:

Jones Haven for Women Interest Form

SECTION 1: APPLICANT INFORMATION

SECTION 2: HOUSING NEED & RELOCATION

SECTION 3: CURRENT HOUSING STATUS

SECTION 4: INCOME & PAYMENT PATHWAY

SECTION 5: PROGRAM FIT & EXPECTATIONS

SECTION 6: ACKNOWLEDGEMENTS