Application Submission | Luvernes Safe Haven

Your Created Authorization Code

First & Last Name

10 Digit Phone #

Current City & State

List a trusted contact

Birthday

Trusted Contacts Phone Number

Please list any income sources you have.

Please list any allergens

Please explain your reasoning for requesting abuse shelter residency with Luvernes Safe Haven, Inc.

What are you expecting to get by acquiring residency within the abuse shelter home?

Application approval is based on the applicants needs, and the organization's availability (rooms) only. Approved applicants must move in the shelter within no less than 2 weeks of approval and upon the 15th day if not moved into the shelter, the application's approval is revoked. Please state I understand if understood in the box below.

Approved applicants are expected to occupy the shelter with other domestic violence survivors & employees of the organization. Some organizational programs and services will be administered by both men and women. Please list any concerns about such occurrences.

Approved applicants are expected to complete the entire process (program) uninterrupted. Can you committ to at least 60 days within the shelter home?

If approved for residency, please list the ways you feel the organization can best support you?

All abuse shelter services and programs are free. We do not pay resident's bills, but may have an allowance for certain matters. Please list any matters of concerns in which you may need financial assistance upon entering into the shelter.

Please use the box below to share anything not addressed in the prior questions.

Thank you for submitting your application. Please check your email within 48 hours for updates on your application status.