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Lion House Application
Case Managers will reach out once application has been submitted to do an intake assessment. (Some Emergency Housing is available for those ages 18-24)
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* Indicates required question
Email
*
Your email
Name (First, Last)
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Your answer
Please describe your race:
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Age
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Your answer
Gender
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Your answer
Pronoun(s)
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Your answer
Do you identify as LGBTQ+?
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Your answer
Are you a Wyandotte County resident?
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Yes
No
Other:
Where are you living right now (house/apt, friends, relatives, shelter, hotel, street, car, other)?
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Your answer
Phone Number
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Your answer
Email
*
Your answer
Alternative means of contact (Facebook, Instagram, etc.)
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Your answer
Preferred method of contact?
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Email
Phone
Text
Social Media
Have you ever applied to this program?
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Yes
No
How did you hear about Lion House?
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Your answer
Do you know anyone who is or has been in the Lion House program?
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Yes
No
Maybe
What are your reasons for applying to the Lion House program?
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Your answer
Have you ever been in any other independent living program? (Examples include Hillcrest, ReStart, Synergy)
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Yes
No
Are you currently working with a case manager? (If yes, please list name and contact number)
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Your answer
Do you currently have children in your custody?
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Yes
No
Maybe
What form of transportation do you use?
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Your answer
Are you currently enrolled in school? (If yes, please list school name)
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Your answer
Are you currently fully vaccinated against COVID-19?
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Yes
No
Let us know if you have any questions about the Program, or further comments on any sections of the applications.
Your answer
A copy of your responses will be emailed to the address you provided.
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