Family Intake & Referral

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Family Promise of Genesee County

Each year, Family Promise of Genesee County provides food, clothing, comprehensive case management, life skills training, to families experiencing a housing crisis.
In 2019, we provided 2,846 safe nights of sleep and 8,538 meals for homeless children and their families seeking emergency assistance. Our Emergency Shelter Program serves residents across Genesee County.

We also provide prevention and stabilization support for families facing eviction or foreclosure (based upon available funding).

To streamline the referral process and minimize our waiting list, we have developed an online Centralized Intake Screening (CIS) process. Completing this screening does not guarantee placement; however, it is strongly encouraged.

*This online application will take approximately 10 minutes to complete.*

Once our Case Manager receives the referral, we will contact the applicant to complete the intake process.

Applicants will be asked to EMAIL important documents. If they or the referring agency are unable to do so, they will be required to bring:

-Birth certificates
-Social security cards
-Insurance cards
-Photo ID (for all adult household members)
-Immunization records (for all minor household members)
-Custody documentation (where applicable)
-Court Order/other legal documents (where applicable)

*We can assist in obtaining lost/stolen birth certificates, social security cards, and photo ID.

If you are unable to complete the form online, please email us at intake@familypromiseofgc.org

Email *

Today's Date *

YYYY

Are you a Social Service Referral Agency? If yes, which agency? *

Catholic Charities

Carriage Town Ministries

Family Promise Graduate

Family Service Agency of Mid Michigan

Genesee County Community Action Resource

Host/Support Congregation

Shelter of Flint

None, I am referring myself and family

Other:

First Name of Lead Applicant *

**If you are helping someone apply, DO NOT enter your name here, Use NOTES field at the end of application. Thank you.

Last Name of Lead Applicant *

Lead Applicant Address, City, State, & Zip Code *

Please provide even if you are staying at this residence temporarily.

Lead Applicant Phone Number *

What is your gender? *

Female

Male

Non-Binary

Prefer to self-identify

Other:

Your Date of Birth *

YYYY

Which of the following best describes your current relationship status? *

Married

Divorced

Separated

In a domestic partnership or civil union

Single, never married

Widowed

Single, but co-habituating with a significant other

Required

Do you have the following items for yourself? (Please check all that apply) *

Valid Driver's License

Photo ID

Birth Certificate

Social Security Card

Bank Account

Proof of Income

None of These

Required

What is your racial or ethnic identity? (Select all that apply)

Asian or Asian American

African American/Black

American Indian or Alaska Native

Hispanic or Latino

Native Hawaiian or other Pacific Islander

Pacific Islander

White or Caucasian

Some other race(s) not listed

Are you a Veteran?

Yes

Clear selection

Including yourself, how many people are in your household? *

Clear form

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