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Welcome to our new intake portal which allows you or members in the related services industry to submit an online emergency request for housing services, mental health services, or instructional training. Please complete the form below and a member of our team will contact you within 72 hours. Please be advised, all information submitted is confidential and any medical responses received are protected by HIPPA especially as our facility does adhere to HIPPA confidentiality laws/policies. Since we are a boarding house program, we must exercise cautions against communicable diseases and other pubic health issues. Therefore, interested participants may be required to secure medical testing/screening at one of our partnering health facilities.  Lastly, new incoming participants are required to pay a $175.00 non-refundable admission fee which covers standard program materials, supplies, and onboarding processing. Acceptable forms of payment will be determined if intake request is approved.

We are here to help you!

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Select services needed (check all that apply)

Be sure to upload any pertinent documents (i.e. discharge papers, patient/client evaluation, DOC release forms, referral forms, etc.). The more supporting data we receive in advance will help to expedite your request for services in timely manner. 

Upload File

Thank you for submitting! A member of our staff will contact you in 72 hours with a determination of your request. Please be advised, all new incoming participants are required to pay a $175.00 non-refundable admission fee. Adherence to program guidelines/policies are strictly enforced; therefore, we encourage interested candidates to embrace the positive transformation & innovative environment we offer.

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