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Information You Will Need to Fill Out Our Application
Our Application is very thorough and long. We recommend that you create a Username and Password so you can save your information and come back to either continue or update your information. Below is the information you will need to fill out our application.
- Referring Agency Information
- Drug History
- Medical Insurance Information
- Medical History
- Psychiatric History
- Medication Information
- Military History
- Employment History
- Income Status
- Legal History
- Education
- Marital History
- Living Arrangments
- Emergency Contact Information
- Your Goals and Plans
Homeless Veterans Facts
National estimates indicate that more than 275,000 veterans are homeless on any given night; and that more than 500,000 experience homelessness over the course of a year.- 23% of the homeless population are veterans
- 25% have used homeless services
- 33% of the male homeless population is made up of veterans
- 46% are age 45 or older, compared to 20% of non-veteran homeless citizens
- 47% are veterans from the Vietnam Era
- 76% experience substance abuse, mental and physical health problems
- 85% completed high school/GED, compared to 56% of non-veteran homeless