Online Housing Interest Application

Online Housing Interest Application
Safe Home. Stronger Tomorrow. Brighter Future.

Thank you for your interest in Redemption Safe Housing LLC. 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 $750 per month

Includes:

• Furnished shared bedroom
• Utilities included
• Wi-Fi included
• Household essentials provided
• Cleaning supplies and laundry detergent included
• Washer and dryer in the home
• Shared common living areas
• Safe, clean, and structured living environment
🛏️ Private Room
Starting at $950 per month

Includes:

• Private furnished bedroom

• Utilities included
• Wi-Fi included
• Household essentials provided
• Cleaning supplies and laundry detergent included
• Washer and dryer in the home
• 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

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Housing Information
Which housing option are you interested in?
Is your housing need temporary?

Applicant Acknowledgment
Please read each statement carefully and check each box to acknowledge your understanding and agreement.
Electronic Signature
Applicant's Full Name

First NameLast Name
Applicant Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Contact Information
Redemption Safe Housing LLC
Phone: 904-664-4366

Email: info@redemptionsafehousing.net

Safe Home • Stronger Tomorrow • Brighter Future
Should be Empty:

Housing Options & Pricing