Dallas Hope Center General Intake Form
If you are seeking housing assistance, please fill out below. Please note that we are currently looking at a 24month waitlist.

Please visit our resource page at https://www.dallashopecharities.org/resources/ for additional organizations that may be able to assist you.

If you have any questions, please reach out to Hope@DallasHopeCharities.org
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Name: *
Legal name (if different):
Phone Number: *
Alternate Number:
Best times to reach you: *
Required
Age: *
Date of Birth: *
MM
/
DD
/
YYYY
Gender Pronoun(s): *
Sexual Orientation: *
Gender Identity: *
Required
1. Have you been convicted of the illegal manufacture or distribution of a controlled substance within the last 10 years? *
2. Are you currently on probation or parole? *
3. Do you have any prior criminal or violent acts? *
5. Are you required to register as a Sex Offender? *
6. Are you currently an illegal abuser or addict of a controlled substance? *
7. Do you require the provision of personal care services? *
Additional Comments/Info: Is there any additional information that you would like us to consider when reviewing? i.e. You are applying on behave of someone you know?, You are reaching out to be proactive in your living situation?, You are looking for solutions prior to coming out to your family/guardian(s)?, etc.
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