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Pathways Waitlist Request Form
Some of our shelter programs are currently waitlisted. To be added to the waitlist, please fill out the below form or call 605-665-8994. This request does not guarantee you a spot. Waitlisted household are still screened to ensure they meet our criteria. If they do not meet our criteria, they will be referred to other resources that can meet their needs.
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* Indicates required question
Type of Shelter Requested
*
Family Shelter (with minor children)
Individual Shelter (Adults Only)
Head of Household Name
*
Your answer
Head of Household Date of Birth
*
MM
/
DD
/
YYYY
Contact Information for household (phone number, email address, etc.)
*
Your answer
other household members names & dates of birth (if applicable, if only single adult, put N/A)
Your answer
Income information (Select all that apply)
*
Social Security Benefits
Child Support
TANF
Employment
No Income
Required
Current Living Situation
*
staying with Friend
staying with family member
facility (jail, prison, hospital, treatment center)
sleeping in vehicle
sleeping outside/camping
rental property at risk of eviction
Other:
Are you currently on probation or parole?
*
Yes
No
Do you currently have any pending legal charges
*
Yes
No
Do you understand and agree to follow the rules and expectations of the program you are applying to? Program rules can be found on the website yanktonpathways.org
*
Yes
No
By checking the boxes below, you state that you understand that this waitlist request does not guarantee you a spot at Pathways.
*
all households in shelter must be screened before they can enter shelter. Being added to this waitlist today is not a guarantee that we will be able to serve you in shelter programs. You will need to be screened first.
by being added to our waitlist, you agree to have a background check completed to ensure you meet our qualifications. We do not accept anyone that is currently on the sex offender registry, 3+ violent offenses in the last year, or anyone with an active warrant.
by being added to our waitlist, you agree to be screened for prior Pathways enrollments. We are unable to serve the same households repeatedly due to limited resources and housing availability.
by being added to our waitlist, you also agree to follow the rules of the shelter program, which include zero tolerance for drugs and alcohol, zero tolerance for violence, and a requirement to comply with case management
by being added to our waitlist, you confirm that you are able to care for yourself without 24 hour supervision. Pathways is not a long-term care facility.
Required
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