Apply for Assistance : What We Do : ACROSS

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Are you aware that we are full at this time and are not receiving applications?

Your Name

First Name *

Last Name *

AKA

DOB

Email

Phone

DL/ID #

Would you prefer text, call, or e-mail?

What is your current housing situation?

Apartment/House
Friends/Family
Motel
Vehicle
Tent
Other

Current Location

What kind of assistance are you requesting?

Emergency Shelter
Interim Housing
Safety from Domestic Violence
Sober Living Assistance

What has led you to reach out for assistance?

Are you a veteran?

Yes
No

Do you have valid identification?

Valid Driver's License
Passport
Social Security Card
Birth Certifcate
No Valid ID

Do you have a criminal record? If yes, please explain.

Reference 1:

First Name *

Last Name *

Association to Reference:

Reference Phone Number:

Reference E-mail:

Reference 2:

First Name *

Last Name *

Association to Reference:

Reference Phone Number:

Reference E-mail:

Are you employed?

Yes
No

Employer Phone Number:

If so, where?

Please list your job history for the last 5 years:

Are you a student?

Yes
No

If so, where?

School Phone Number:

Do you have a vehicle?

Yes
No

Do you have a car payment?

Yes
No

How many adults are in your household? (PLEASE NOTE: Each adult must fill out an application.)

How many children are in your household?

Names and Ages of children:

Anything else you would like to share with us?

How did you hear about A-CROSS?

Apply for Assistance

At this time, we are currently at full capacity and are unable to accept applications. We encourage you to review the resources provided in our resource packet for alternative options and assistance.

Two References that can attest to your current situation (Non-Family Related):