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89 Grove Way, Roswell, GA 30075
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About Us
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Apply Online
Volunteer
Individual Volunteer Sign Up
Group Volunteer Sign Up
Events
Peachtree Tea
Run the River
Donate
General Donations
Unit Sponsorship
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
