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Make a Referral

Apply for our Waitlist

We are committed to serving everyone who needs us. Due to high demand, placement is based on availability.

What Affects Your Place on the Waitlist:

  • Availability of beds in: women's rooms or men's rooms (rooms are gender-specific)

  • Date and time your completed application is received

  • Program eligibility based on individual needs assessment

  • Current resident census and room availability

We encourage you to apply even if rooms are currently full. We will contact you as soon as a space becomes available.

Waitlist Application Form

Fields marked with * are required

Date of Birth
Month
Day
Year
Gender Identity
Current Living Situation
Are you currently enrolled in a substance use treatment program?
Yes
No
Recently Completed
Do you have a case manager or social worker?
Yes
No
What services are you most in need of?

By submitting this form, you agree and understand that this application does not guarantee immediate placement and that my position on the waitlist depends on availability and eligibility.

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