Application Form

Full Name *

Date of Birth *

Email *

Phone *

Current Address *

Name *

Relationship *

Phone Number *

Current Living Situation *

Are you currently employed? *

Do you have a valid ID? *

Do you have a driver’s license? *

Do you have reliable transportation? *

Are you willing to live in a drug-free environment? *

Briefly explain your current situation

What goals would you like to accomplish while staying at Sheila’s House?

Have you previously lived in transitional housing?

I understand that Sheila’s House is a drug-free and supportive living environment. I agree to follow all house rules, respect staff and residents, and participate honestly in the intake process.

Signature *

Date *

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