Pre-Application

NATASHA House Pre-Application Screening
Thank you for your interest in NATASHA House, where we provide more than just transitional housing. Our program consists of transitional housing, for up to 2 years, combined with required participation in supportive services and programs to help you build a stable, sustainable future for your family to grow, learn, and be empowered! If you’re interested in change, and you’re ready to take ownership of the process, we are here to walk with you as you do the work.
Are you seeking Emergency Shelter? If so, please call the Crisis Hotline, as we are unable to provide emergency shelter. Their number is 757-587-4202*

YesNo
Are you CURRENTLY in a domestic abuse situation? If so, unfortunately, we are unable to provide housing for the protection of our staff, volunteers, and other families. (Please reach out to the following organizations for help: Transitions - 757-723-7774, Avalon - 757-258-5051, or the National Domestic Violence Hotline - 800-799-7233)*

YesNo
Have you contacted NATASHA House previously to inquire about housing?*

YesNo
City/Town You are Currently In:*
Race (note: this is needed for data collection purposes only, which enable us to obtain grant funding for our programs)*

Black or African AmericanWhiteNative AmericanAsian AmericanOther
Number of children for whom you CURRENTLY have custody*
By checking the box below, you confirm that all information on this form is true and correct.

Yes, all information provided on this form is true and correct.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
THANK YOU! Once you click "Submit" below, you will receive an email within 24 hours with next steps. (Please be sure to check your spam folder in case it ends up there.)
Should be Empty:

NATASHA House Pre-Application Screening