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89 Grove Way, Roswell, GA 30075
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About
About Us
Board & Team
Programs
Resources
Apply Online
Volunteer
Individual Volunteer Sign Up
Group Volunteer Sign Up
Events
Peachtree Tea
Run the River
Donate
General Donations
Unit Sponsorship
Kid’s Summer Programming
Contact
First Name *
Middle Initial *
Last Name *
Email *
Phone Number *
xxx-xxx-xxxx
Are you 21 years or older? *
Yes
No
Date of Birth *
Gender *
Male
Female
Marital Status *
— Select —
Single
Living Together
Married (seeking housing with your spouse)
Separated (not living together and seeking separate housing)
Divorced
Widowed
Other
Are you a: *
US citizen
Permanent Resident
DACA Recipient
Other
Where did you sleep last night? *
— Select —
Non-housing (place not meant for habitation)
Emergency shelter or hotel paid for with a voucher
Transitional housing for homeless persons
Psychiatric facility
Substance abuse treatment facility
Hospital
Jail/prison
Domestic violence situation
Living with friends/relatives
Rental housing
Hotel paid by you
Other
Number of minor children in your custody? *
— Select —
-0-
1
2
3
4
5
More than 5
Are you employed? *
Yes
No
Is your current Job, School or Housing within one of the listed zip codes? *
— Select —
30004
30005
30009
30022
30024
30075
30076
30092
30097
30328
30342
30350
None of the above
How long have you been employed? *
— Select —
Less than 6 months
6 months or more
Are you willing and physically able to work a fulltime job (not self-employed)? *
Yes
No
Is your homelessness the result of fleeing a domestic violence situation? *
Yes
No
