Get Some Assistance

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Get Some Assistance

We've made this questionnaire available so that we can gather crucial information up front, which will help our team better understand your situation and link you with care options. Please don't forget to also visit our resource page for more help in-between.

Your full name *

Your current location/ and or zip code

Current age

Your phone number *

Email Address

I am in need of: *

I am currently: *

Chronically Homeless: A person who often lacks a fixed, regular, and adequate nighttime residence more than 3 times in past 2 years

A person with a primary nighttime residence that is a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings, including a car, parking lot, woods, abandoned building, bus or train station, airport, or Walmart.

A person living in a supervised public or privately-operated shelter designed to provide temporary living arrangements

A person who resided in a shelter or place and/ or who is exiting an institution where he or she temporarily resided

A person who will imminently lose their primary nighttime residence, provided that: (i) Residence will be lost within 14 days of the date of application for homeless assistance; (ii) No subsequent residence has been identified; and (iii) The individual or family lacks the resources or support networks needed to obtain other permanent housing

Unaccompanied youth and homeless families with children and youth defined as homeless under other federal statutes who i) have experienced a long term period without living independently in permanent housing; ii) have experienced persistent instability as measured by frequent moves over such period, and iii) can be expected to continue is such states for an extended period of time.

A person who is fleeing, or is attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions in the individual's or family's current housing situation, including where the health and safety of children are jeopardized, and who have no other residence and lack the resources or support network to obtain other permanent housing.

A person who was recently released from incarceration, and beeen homeless in the previous 60 days but has since found no housing.

Other:

I have been:

released from jail or a treatment facility

recently evicted

asked to leave my location

unable to afford my current location

in an abusive or domestic situation

in another program

in a hospital

Option 8

Clear selection

I have been in this situation for: *

As of today

About a week

A couple of weeks

Some months now

I do have: (check all that apply) *

a job

a vehicle

a child

more than a child

a valid GA ID

a plan of action

a housing voucher

Other:

Required

my challenge in finding housing is: (check all that apply) *

fresh out of jail or treatment

out of hospital from surgery

unable to afford

on the Regisry

on bond

family dispute unable to return

I've never had any

currently in accountability court

no friends or family to help

stay at motel is up

Other:

Required

Please describe your situation in fair detail, and your request for assistance: *

Please contact me by *

Phone

Email (if so choosing this please include your email address above)

Submit

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