Get Help

If you are interested in the Acres of Hope program, please fill complete the fillable inquiry form to the best of your ability. We will review your inquiry as soon as possible. If you are a good candidate to participate in the Acres of Hope program, our intake coordinator will contact you for a prescreening and interview.

Online Application

Refer a Candidate

The success of Acres of Hope depends upon strong community support and partnerships. We consider our program to be an extension of the many services already available to the homeless community. We invite anyone to make referrals to the Acres of Hope program.

Referral Form

Who is a good candidate for admission?



Homeless

Applicants must be homeless, facing homelessness or exiting a homeless service program.



Children

Acres of Hope accepts applications from mothers with children of approximate ages of 12 years & younger.



Referrals

Acres of Hope invests heavily in our residents. Referrals serve as a testimony to the applicant’s willingness and capability to take full advantage of the program.



Drug & Alcohol Free

Residents must be drug and alcohol free for a minimum of three months prior to admission.



Smoke-Free

Residents must have stopped smoking prior to entry. They may utilize a nicotine patch for up to six weeks after arrival.

Download Application

First Name*

Middle Name

Last Name*

Birthdate (MM/DD/YYYY)*

Primary Language*

Secondary Language

US Citizen?*

Marital Status*

Current Living Status*

Mailing Address*

Phone Number*

Alternative Phone Number

Email*

Are you on probation/parole?*

Are you a sex offender?*

Officer's Name

County

Phone

Have you been drug and alcohol-free for at least 3 months?*

Clean Date (MM/DD/YYYY)

What medications are you currently taking?*

Are there any mental health or medical diagnosis?*

Please note that every applicant, including your child(ren), must have a clear TB test within the last year at admission, be current on immunizations, and children must be in the 6th grade or below in order for the family to qualify.

Do you have an open CPS case?*

CPS Worker's Name

County

Phone

How many children do you have?*

List children from oldest to youngest

Child 1

First Name*

Last Name

Last Name*

Age*

Birthday (MM/DD/YYYY)*

Gender*

Living with mother?*

Father's Name*

Custody Status*

Your current custody/visitation arrangements?*

Child 2

First Name*

Middle Name

Last Name*

Age*

Birthday (MM/DD/YYYY)*

Gender*

Living with mother?*

Father's Name*

Custody Status*

Your current custody/visitation arrangements?*

Child 3

First Name*

Middle Name

Last Name*

Age*

Birthday (MM/DD/YYYY)*

Gender*

Living with mother?*

Father's Name*

Custody Status*

Your current custody/visitation arrangements?*

Get Help

Refer a Candidate

Who is a good candidate for admission?

Homeless

Children

Referrals

Drug & Alcohol Free

Smoke-Free

Together we can help end homelessness for women and children

Get in Touch

Helpful Links