Jones Haven for Women & Children

Jones Haven for Women & Children

Supporting Women With Children on the Path to Stable Housing
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.
SECTION 1: Applicant Information
Name

First NameLast Name
DOB

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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.Format: (000) 000-0000.
SECTION 2: Housing Need & Timeline
Are you currently in need of housing?

YesNo
How soon are you looking to move?

Immediately (within 30 days)30–60 daysLater / exploring optionsType option 4Other
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.
SECTION 3: Household Composition (Children)
How many children would be moving with you? (Number)

Please list each child who would be living with you.

Rows	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
SECTION 4: Income & Financial Stability
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
SECTION 5: Shared Living Acknowledgment
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
SECTION 6: Program Fit & Expectations
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?
SECTION 7: Additional Information
Is there anything you would like us to know that may impact housing placement, room assignment, or timing?
SECTION 8: Certification & Acknowledgment
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.
Should be Empty:

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