Apply for housing support

Complete the application below to request transitional housing and recovery support from Shekinah Communities, Inc.

Application details

Please provide accurate information so our team can review your request and follow up with next steps.

Name*

Date of Birth*

Present Address*

Current Phone*

Are you an alcoholic?*

If yes, date of last drink

Are you addicted to drugs?*

If yes, date of last use

Have you ever attended a support group or gotten treatment for substance abuse?*

When was your first attempt at recovery?

What groups or meetings are you attending to help you in recovery?

Do you want to stop using alcohol and drugs?*

Are you employed?*

If yes, who is your employer?

Are you getting welfare or other non-job related income?*

If you do not have a job, will you get one?*

What is your monthly income right now?

What do you expect your monthly income to be next month?

Do you have a medical doctor? If yes, what is their name?

Have you ever been to a treatment facility for any substance? If yes, list provider.

Do you take prescription drugs?*

If yes, list them.

Ready to begin? Submit your application and our team will review it as soon as possible.