Housing Support - The Welcome House Foundation

Request Housing Support

Please complete the intake form below so our admissions team can better understand your situation and determine what support options may be available. Completing this form does not guarantee housing placement, but it allows us to review your needs and coordinate next steps when possible.

HOUSING SUPPORT

Name

Date of Birth

Email

Phone Number

Current Housing Status

How long have you been without stable housing?

Household Type

Individual

Family

Single Parent

Number of Family Members

Are you currently in recovery?

Yes

No

Prefer not to say

Are you a veteran?

Yes

No

Are you aging out of foster care?

Yes

No

Were you referred by an organization or caseworker?

Yes

No

Referral Organization / Caseworker Name

Address Line 1

Address Line 2

City

State

Zip Code

Is there anything else you would like us to know about your situation?

I understand that completing this intake form does not guarantee housing placement. I give permission for The Welcome House Foundation to review my information and contact me regarding next steps.

Confirmed