Start your journey

JOIN OUR COMMUNITY

A Safe Place Begins With a simple conversation

We know that finding the right home can feel overwhelming. Please complete the form below to tell us about your situation. Our caring staff will be in touch shortly to guide you through the next steps.

First Name

Last Name

Date of Birth

Phone Number

Where are you currently staying?

What brings you to seek housing at this time?

When do you need to move?

Have you experienced homelessness before? (Optional)

Yes No

Are you comfortable living in a shared home with other residents

Yes No

Are you able to manage your daily personal care independently?

Yes No

Do you need assistance with any of the following:

Medication management Mobility Cooking / meals None

Do you currently have a caregiver or case worker?

Yes No

Do you currently have a source of income?

Yes No

What's your Monthly income range?

$0-$1,000 $1,000-$5,000 $5,000-$10,000 Above $10,000

Are you receiving:

SSI / SSDI VA benefits Other assistance None

Do you have any medical or mental health conditions we should be aware of to better support you?

Do you smoke?

Yes No

Do you drink alcohol?

Yes No

Is there anything else you’d like us to know about your situation?

Let’s Talk About Your New Home

Schedule a Visit

Providing affordable and inclusive housing in a safe community. We believe everyone deserves a warm and loving place to call home.

Contact

708-305-4307

houseofhearts2021@gmail.com

Opening Hours

Monday - Friday :

9AM - 5PM

Weekend :

CLOSED

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