SHELTER ELIGIBILITY QUESTIONNAIRE
Thank you for your interest in our housing opportunities. The Salvation Army Shelter reviews initial request for a shelter unit and provides assistance based on eligibility. Please fill out this questionnaire. Once we receive your questionnaire, you will be contacted as soon as out schedule allows.

Please provide us with your name, contact information and an alternative contact number that we can safely contact you.
Date
MM
/
DD
/
YYYY
First Name *
Last Name *
Primary Phone number *
(000) 000-0000
Secondary Phone Number
(000) 000-0000
Email Address
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