Application
HOW TO APPLY:
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Download application.
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Read the Confidentiality Statement, Community Agreements, and Orientation Policy.
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Complete the Admission Requirements Checklist, Homeless Status Verification, the applications-Residency and Release of Information(s) forms
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Release of Information (ROI) instructions: Complete one ROI per person. Fill out the releases of information with your full legal name, date of birth and the person or agency you would like Samantha’s House Inc. to obtain or share information with. Be sure to give us the complete name, address, telephone number, and fax number (if applicable) for each person you sign a release for. Check appropriate boxes and put an expiration date in the box. Finally, sign your full name and date in Black ink when possible. Please note that we can’t talk with anyone regarding your application without a completed Release of information.
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Please speak to a staff person and they will determine the best way to return the application
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You will need to have a current physical/health check from the Health dept or be prepared to access a physical/health check within your first 30 days upon admittance.
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Bed Availability: Check in with the director or CEO at least once a week. Applicants that are incarcerated need to community at least monthly. If Samantha’s House Inc. has not heard from you within 30 days, your application will be removed from the waiting list. You may appoint someone else to check in for you, but you must sign a “ROI” as instructed above.