Redemption Safe Housing
Online Housing Interest Application
Safe Home. Stronger Tomorrow. Brighter Future.
Thank you for your interest in
Redemption Safe Housing
. We are committed to providing safe, stable, and supportive housing for adults working toward greater independence and self-sufficiency.
Please complete this application as thoroughly as possible. Once your application is received, our Admissions Team will review your information and contact you within
1-3 business days
regarding the next steps.
Housing Options & Pricing
Shared Room
Starting at $800 per month
Approximately $185 per week
Includes:
Furnished shared bedroom
Utilities included
Wi-Fi included
Shared common living areas
Safe, clean, and structured living environment
Private Room
Starting at $1,000 per month
Approximately $230 per week
Includes:
Private furnished bedroom
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Utilities included
Wi-Fi included
Shared common living areas
Safe, clean, and structured living environment
Required Program Fee
$200 Non-Refundable Program Fee
Due after acceptance into the program and prior to move-in.
Applicant Information
Full Legal Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Current Address
Housing Information
Which housing option are you interested in?
Shared Room - Starting at $800/month (approximately $185/week)
Private Room - Starting at $1,000/month (approximately $230/week)
Is your housing need temporary?
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Yes
No
If yes, anticipated length of stay:
3 Months
6 Months
12 Months
Other
Desired Move-In Date
Previous Housing Experience
Have you previously lived in a shared housing environment with others?
Yes
No
If yes, please briefly describe your experience.
Current Living Situation
Homeless
Staying with Family or Friends
Renting
Transitional Housing
Recovery Housing
Other
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Income Information
Primary Source of Income
Primary Source of Income
Employment
SSI / SSDI
Veteran Benefits
Retirement
Other
Community Support Services
Are you currently receiving any community support services?
Community Support Services
Case Management
Behavioral Health Services
Substance Use Recovery Services
Veteran Services
Employment Services
Faith-Based Support
Other Community Services
None
If "Other," please describe:
Referral Information
How did you hear about Redemption Safe Housing?
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Self-Referral
Hospital
Social Worker
Case Manager
Behavioral Health Provider
Community Agency
Veteran Services
Faith-Based Organization
Family or Friend
Other
Other
Housing Goals
Please tell us why you are seeking housing and what you hope to accomplish while living at Redemption Safe Housing.
Best Time to Contact You
Morning (8:00 AM - 12:00 PM)
Afternoon (12:00 PM - 5:00 PM)
Evening (5:00 PM - 8:00 PM)
Preferred Phone Number (if different)
Format: (000) 000-0000.
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Applicant Acknowledgment
Please read each statement carefully and check each box to acknowledge your understanding and agreement.
I understand that Redemption Safe Housing is a non-medical Independent Living Program.
I understand that I must be independent with activities of daily living and able to safely live in a shared housing environment.
I understand that Redemption Safe Housing maintains a drug-free and alcohol-free living environment, and I agree to comply with this policy.
I understand that housing is provided on a month-to-month basis and is subject to continued eligibility, compliance with program requirements, and housing availability.
I understand that program rules, payment expectations, and safety requirements must be followed throughout my residency.
I understand that Shared Rooms start at $800 per month (approximately $185 per week) and Private Rooms start at $1,000 per month (approximately $230 per week).
I understand that a $200 non-refundable Program Fee is required after acceptance into the program and prior to move-in.
I understand that payment of the Program Fee does not guarantee housing placement. Placement is based on eligibility, program suitability, and bed availability.
I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge.
Electronic Signature
Applicant's Full Name
Applicant Signature
Date
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Contact Information
Redemption Safe Housing
Phone:
904-664-4366
Email:
info@redemptionsafehousing.net
Safe Home • Stronger Tomorrow • Brighter Future
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