Pivotal Point Application Form

At Pivotal Point Transitional Housing we provide rent and utility free apartments for individuals facing homelessness or housing insecurity. While staying in our fully furnished apartments, you sign a written contract to participate in our transitional housing program. The program has very rigorous educational components focusing on case management, budgeting, life skills, and community living. Please read the following document very carefully and follow the instructions to apply to Pivotal Point Transitional Housing.

All participants in our 90-day transitional housing program must be employed full-time, obtaining 35-40 hours per week. Participants must be open to following a strict weekly budget plan in order to save money and pay off debt, with the ultimate goal of obtaining permanent housing.

Transitional housing program participants must be able and willing to attend weekly case management sessions, which will be scheduled around the participant's work and school commitments, within a 9am to 5pm timeframe. Additionally, participants are required to attend a Life Skills class every Tuesday at 6:30pm. Community chores will also be assigned to each resident.

Pivotal Point Transitional Housing Program (PPTH) serves working individuals amd single-parent families in Buchanan County and surrounding areas. This program is a short-term transitional program of 90-days, in which participants must save or pay off debt in order to move into a home of their own. PPTH participants must agree by written contract to attend weekly meetings with a case manager, budget counselor, and life skills coordinators. All applicants must leave a voicemail twice a week on our check-in line at (816) 689-1383 to be considered for an interview. When we have an opening available we will call those who have been checking-in weekly. Securing an interview does not guarantee you will be selected into the program. If offered a placement, we will contact the applicant and explain the intake process.

Full Name*

First NameLast Name

Birthdate*

Date

Social Security Number*

Highest Education Completed

Email*

example@example.com

Phone Number*

Area CodePhone Number

Current Marital Status*

Gender*

Race*

Zip code*

Are you a veteran?*

YesNo

Do you have a disabling condition?*

YesNo

Are you Hispanic?*

YesNo

Please write your name as found on social media.*

Add all who would be staying in apartment

Dependents

Are you currently enrolled in school or taking any classes? If yes, how many hours?*

Is anyone pregnant?*

Current Address:*

How long have you lived at current address?*

Have you been asked to leave your current living situation?*

If yes, how long can you stay there?

How did you hear about our agency?*

Have you been involved with a similar program?*

YesNo

If yes, what program?

What mode of transportation do you use?*

Has anyone in the household served in the military?

Are you currently working?*

YesNo

If yes, where?

Start Date

Date

Pay Rate

How many hours a week do you work?

Previous Employers:*

Income currently received from employment, SNAP (formerly known as food stamps), TANF, child support, SSI, etc.*

List all monthly expenses*

List all debts*

How many evictions do you have?*

Do you or anyone in the household have a medical diagnosis that requires ongoing treatment?

YesNo

If yes, please describe.

Do you or anyone in the household receive any medical or counseling services?

YesNo

If yes, please describe.

Are you, or anyone in your household, diagnosed with any mental health disorders? If yes, list prescribed medications if applicable.

YesNo

If yes, please describe.

Are you currently receiving counseling services?

YesNo

Therapist/Organization name:

Have you ever been in a mental health hospital?

YesNo

If yes, please describe.

Have you consumed drugs or alcohol in the past 30 days?*

YesNo

Have you ever been to drug or alcohol rehab*

YesNo

If yes, name the treatment center and dates/length of stay:

Name of substances abused:

Have you ever been arrested or charged with a crime? If yes, please describe.*

Have you ever been incarcerated? If yes, when and where?*

Are you currently on probation or parole? If so, what is the name and contact information for your probation or parole officer?*

Name any other case managers or social service organizations you are involved with:

Are you the victim of domestic violence?*

YesNo

Please explain the reasoning for your current situation of housing instability and why you are applying to the program:*

Right to Deny Services

Name

First NameLast Name

Applicant Requirements

Transitional Housing Program