House of Dreams Application - SVDP Georgia

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House of Dreams Application

House of Dreams is a transitional housing program for homeless women without children who are willing and able to change their own lives and become self-sufficient. Located in Smyrna, GA, House of Dreams provides shelter, life and work skills classes, job assistance and more.

Please note that ALL ELIGIBILITY REQUIREMENTS must be met in order to be considered for the House of Dreams Program.
– Women only
– 25 Years or older without dependent children
– No criminal, alcohol, or drug history
– No medical issue that prohibits them from working
– Must have been recently employed (within the last 3-6 months) or currently working

We are currently full. For other resources such as food and utilities, please call the SVdP assistance line at 678-892-6163 and follow the instructions to connect with your local Conference. Please check back at a later date for an update on program availability, or complete the application below to be placed on a waitlist.

For more information, please call (678) 892-6188 or email Laura Gibbs at lgibbs@svdpgeorgia.org

Date
MM slash DD slash YYYY
Applicant Information
Name*
First Middle Last Maiden
SSN
Last 5 digits
Date of Birth*
Month
Day
Year
Gender*
Race*
- American Indian/Alaskan Native
- Asian
- Black
- Caucasian
- Hispanic/Latino
- Native Hawaiian/Pacific Islander
- Other
If other, please list.*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
How long at this address?
Primary Phone*
Other Phone
Marital Status*
Please provide the name of the individual or organization that referred you to House of Dreams:
Employment History Information
Are you employed?*
- Yes
- No
Date of Unemployment*
MM slash DD slash YYYY
Briefly, please explain why you are not employed:
Employer or Most Recent Employer
*
- Full-time
- Part-time
How long employed:*
Household Make-Up
How many children are in household?*
How many adults are in household?*
Total # of People In Household*
Please list first and last name, date of birth and gender for each additional member in your household.
Spouse / Other Adult In Household (if applicable)
Name
First Middle Last
SSN
Last 5 Digits
Date of Birth
Month
Day
Year
Gender
Race
- American Indian/Alaskan Native
- Asian
- African American
- Caucasian
- Hispanic/Latino
- Native Hawaiian/Pacific Islander
- Other
If other, please list.*
Purpose of Request & Amount
Have you been helped by St. Vincent de Paul Georgia before?*
- Yes
- No
Date of last assistance from St. Vincent de Paul Georgia*
MM slash DD slash YYYY
Please tell us about your situation.*
Include the circumstances that led you to this situation and other details pertaining to your need for assistance.
COVID-19 Impact
Has Covid-19 impacted your situation?*
- Yes
- No
How has Covid-19 impacted your situation?*
Please select reason below:
- Loss of employment (Layoff/furlough)
- Loss of wages or loss of working hours
- Positive COVID-19 test
- Loss of wages due to lack of childcare
- Loss of wages/employment due to being of a COVID-19 high-risk population
- Loss of employment due to children at home - virtual learning
Please upload documentation of Covid-19 impact:
Example: Loss of employment/termination letter, unemployment statement, positive Covid-19 test results, paystubs to show loss of wages, etc. *All documentation must have applicant's name on it. (jpg, gif, png, pdf files accepted). If you cannot upload this now, you may be asked to provide it to your caseworker once assigned.
Drop files here or

Max. file size: 50 MB.
Finances
Are you currently receiving the following benefits?
Medicare*
- Yes
- No
Medicaid*
- Yes
- No
SNAP (Food Stamps)*
- Yes
- No
WIC*
- Yes
- No
Veteran*
- Yes
- No
Income (monthly)
Please enter the amount you receive for each.
Alimony
Child Support
Your Employment
Spouse/Roommate Employment
Food Stamps
Retirement/Pension
Social Security
SSI, SSD
TANF (AFDC)
Unemployment
Veteran Benefits
Workers' Compensation
Other
Total Income
Expenses (monthly)
Please enter the amounts you need to pay.
Alimony
Child Support
Child Care
Food
Electricity
Water/Sewer
Natural Gas/Propane/Heating Oil
Telephone
Rent/Mortgage
Prescriptions/Medical
Transportation/Car Payments
Insurance (Auto, Health, Dental, Life)
Loans/Credit Card
Cable/Satellite/Internet
Other
Total Expenses
Please list any bills you would like us to consider for payment:
Please upload documentation of current bills you are requesting to be paid:
(Late/eviction Notice, Mortgage Notice, Late Utility Bill) *All documentation must have applicant's name on it. (jpg, gif, png, pdf files accepted). If documentation is not in the applicant's name, please upload and specify the relationship to the applicant. If you cannot upload this now, you may be asked to provide it to your caseworker once assigned.
Drop files here or

Max. file size: 50 MB.
Please upload proof of residency, income, current pay stubs, bank statement, award letters:
*The documents should have your name and address on it. (jpg, gif, png, pdf files accepted). If you cannot upload this now, you may be asked to provide it to your caseworker once assigned.
Max. file size: 50 MB.
Agencies applied to within the last 12 months (Please give info on all that apply):
Name of Agency
Purpose of Request
Amount Given
Date
Month
Day
Year
Name of Agency
Purpose of Request
Amount Given
Date
Month
Day
Year
CARES Act Funding Grants
I confirm that to the best of my knowledge, I have not received any funds/grants from another non-profit agency that is associated with COVID-19 Relief Assistance .*
- I agree
- I disagree
- I'm not sure
Authorization For Release of Confidential Information:
In consideration of the services to be undertaken or rendered on my behalf by the Society of St. Vincent de Paul, its members, agents or affiliated organizations (hereinafter referred to as "SVdP", I, the undersigned hereby authorize SVdP to receive, from any and all sources, and to release to any person or organization, any confidential information regarding me which may be necessary or useful to SVdP in relation to the services to be rendered. I hereby release SVdP from all liability in any way related to the receipt and/or release of said confidential information. I further understand that the release of this information does not guarantee that assistance will be provided. but that without such information my case cannot be considered. This release expires sixty (60) days after the Undersigned signature date.*
I accept
In consideration of the services to be undertaken or rendered on my behalf by the Society of St. Vincent de Paul, its members, agents or affiliated organizations (hereinafter referred to as "SVdP", I, the undersigned hereby authorize SVdP to receive, from any and all sources, and to release to any person or organization, any confidential information regarding me which may be necessary or useful to SVdP in relation to the services to be rendered.

I hereby release SVdP from all liability in any way related to the receipt and/or release of said confidential information. I further understand that the release of this information does not guarantee that assistance will be provided. but that without such information my case cannot be considered. This release expires sixty (60) days after the Undersigned signature date.
Signature*
Phone
This field is for validation purposes and should be left unchanged.

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Mission

Providing Help and Hope to Neighbors in Need

Location & Hours

2050-C Chamblee Tucker Road
Atlanta, GA 30341

Monday - Friday:
8:30 AM – 4:00 PM

Contact

Main: (678) 892-6160

Assistance: (678) 892-6163

Pharmacy: (678) 892-6181

info@svdpgeorgia.org

Donations: gifts@svdpgeorgia.org

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