Application for Shelter

Select one or both locations you are willing to have a shelter stay:

Name *

Date of Birth *

Names, genders, and dates of birth for ALL household members coming into shelter:

Phone *

Email

Contact method preferred

We are unable to text at this time.

If you are unavailable when we call, is it safe to leave a voicemail message?

Preferred language

Where have you been staying/sleeping? *

Are you in the Mankato/St. Peter area? *

Current probation/parole/law enforcement involvement

Substance Abuse History/Length of Sobriety

Current domestic violence situation/OFP on file

Person/Agency making referral

Were you referred by another agency?

Referral agency contact info

Currently employed?

Employer

Do you consider yourself or any member of the family to have a physical, mental, developmental, or chronic disability? If so, whom? Please explain:

Any additional health information or special accommodations for staff to be aware of?

If anyone is receiving services from any agencies or working with any professionals, please list them here:

Any additional information that our shelter managers should know?