Jones Haven for Women & Children

Jones Haven for Women & Children – Program Details

Jones Haven for Women & Children is a shared, independent-living housing program designed to support adult women with children who are seeking a safe and stable living environment while working toward long-term housing stability. The program provides structured shared housing in a residential setting where women and their children live alongside other women-led households.

This is an independent living program. Jones Haven for Women & Children does not operate as a shelter, assisted living facility, childcare program, or medical housing. There is no on-site staff, childcare, supervision, or supportive services provided for children. Parents are fully responsible for the care, supervision, and well-being of their children at all times.

Housing is offered in a shared-living model, with furnished bedrooms and shared common areas such as the kitchen, living room, bathrooms, and laundry. Room assignments are based on household size, room availability, and overall program fit. Placement decisions consider safety, capacity, and the ability to successfully participate in a shared household environment.

Jones Haven for Women & Children is intended to be transitional, not permanent housing. Residents are expected to work toward greater housing stability during their stay, which may include securing independent housing in the future. Length of stay and continued participation are based on compliance with program expectations and house rules.

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

Name

First NameLast Name

DOB

Date

Phone Number

Please enter a valid phone number.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Prefferred Method of Contact

CallTextEmail

Emergency Contact - Full Name

First NameLast Name

Emergency Contact - Phone Number

Please enter a valid phone number.

Are you currently in need of housing?

YesNo

How soon are you looking to move?

What is your current living situation?

Staying with family or friendsShelter or transitional housingCurrently homelessUnsafe or unstable housing

What best describes why you are seeking housing at this time?

Housing ending soonFinancial hardshipSafety concernsRelocating

Do you have reliable transportation for work, school, and appointments?

YesNoSometimes

Have you applied to Jones Haven for Women before?

YesNo

Are you currently working with a case manager, social worker, or housing navigator?

YesNo

If you are working with a case manager, social worker, or housing navigator, please provide their contact information below.

How many children would be moving with you? (Number)

Please list each child who would be living with you.

	Child Name	Age	Gender
Child 1
Child 2
Child 3
Child 4

Are any of the children infants (under age 2)?

YesNo

Are any of the children school-aged (ages 5–17)?

YesNo

Do you currently have a source of income or benefits?

YesNo

What type of income do you currently receive? (Select all that apply)

Employment (W2 or 1099)Child supportSSI / SSDITANF / Cash Assistance

Estimated total monthly household income

Jones Haven for Women & Children is a shared living environment. Are you comfortable sharing common areas (kitchen, living room, bathrooms, laundry) with other women and their children?

YesNo

Are you willing to follow house rules related to shared spaces, cleanliness, noise levels, and child supervision?

YesNo

Are you able to live independently and manage your daily responsibilities without assistance?

YesNo

Please acknowledge the following (must check all):

This program does not provide childcare, supervision, or services for childrenParents are fully responsible for their children at all timesThis is transitional housing, not permanent housing

Do any of the children who would be living with you require accommodations, supervision, or services beyond what can be provided in an independent, shared living environment?

YesNo

If yes, please share any additional context you feel comfortable providing (for example, mobility needs, sensory considerations, or supervision needs) that may help us assess housing fit.

What are your long-term housing goals? (Select all that apply)

Become a homeownerRent my own apartment or homeContinue transitional housing for nowNot sure yet

If you’re comfortable sharing, what steps (if any) have you taken toward your long-term housing goals?

Is there anything you would like us to know that may impact housing placement, room assignment, or timing?

Must check all

I certify that the information provided above is true and accurate to the best of my knowledge.I understand that submitting this application does not guarantee housing placement.

Jones Haven for Women & Children

SECTION 1: Applicant Information

SECTION 2: Housing Need & Timeline

SECTION 3: Household Composition (Children)

SECTION 4: Income & Financial Stability

SECTION 5: Shared Living Acknowledgment

SECTION 6: Program Fit & Expectations

SECTION 7: Additional Information

SECTION 8: Certification & Acknowledgment