Jones Haven for Women Interest Form
Jones Community Development Foundation (JCDF) is currently gathering applications and assessing community need for Jones Haven for Women, a shared housing program designed to support women rebuilding stability and transitioning toward independent living. Completing this form helps us evaluate interest and program fit. Submission does not guarantee placement, but eligible applicants may be contacted as housing availability becomes available.
SECTION 1: APPLICANT INFORMATION
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
DOB
-
Month
-
Day
Year
Date
Email
example@example.com
Emergency Contact - Full Name
Emergency Contact - Phone Number
Please enter a valid phone number.
SECTION 2: HOUSING NEED & RELOCATION
Jones Haven for Women is located in Elkton, Maryland. Are you able to relocate to Elkton, Maryland?
Yes
No
N/A
Desired Move-In Timeline
Immediately
Within 30 days
30–60 days
Just exploring
Reason for Seeking Housing
Transition / Stability
Leaving unsafe environment
Financial reset
Other
SECTION 3: CURRENT HOUSING STATUS
What is your current housing situation?(Check all that apply)
Staying with family/friends
Transitional or temporary housing
Homeless or at risk of homelessness
Currently renting
Shelter
Hotel
Other
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 benefits
Support from a third party (case manager, agency, family member)
No current income
Is your employment remote/transferable to MD?
Yes
No
N/A
Employer Name (N/A if not applicable)
Are you seeking third-party payment support?
Yes
No
N/A
Are you able to contribute toward monthly program costs at this time?
Yes
No
With assistance from a third party
SECTION 5: PROGRAM FIT & EXPECTATIONS
Are you applying for housing for yourself only, or yourself and children?
Myself only
Myself and one child
Myself and two children
Myself and three or more children
What kind of housing support would best fit your needs?
Independent shared living
Short-term transitional housing
Longer-term supportive housing
Just gathering information
Would you be open to connecting with support services (employment, counseling, education, etc.)?
Yes
No
Maybe
Jones Haven for Women is a shared housing program, not individual or private housing. Are you comfortable with a shared living environment?
Yes
No
Unsure
Are you able to follow program rules, house expectations, and participate respectfully in a shared community?
Yes
No
SECTION 6: Women With Children
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?
Yes
No
Shared custody / part-time
Does not apply
Do you have a case manager or service provider supporting you?
Yes
No
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 8: ACKNOWLEDGEMENTS
How did you hear about Jones Haven for Women?
Would you like to receive updates when housing becomes available?
Yes
No
Please share anything else you believe is important for us to know when reviewing your application:
Submit
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