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Who We Are
What We Do
Get Involved
- Events
- Volunteer
- Join
- Connect
Ways To Give
The Guardian Society
Members
Get Help

LEAP Referral Form

Please fill out the referral form below.

Name(Required)

First Last

Phone(Required)

Email(Required)

Referral Source(Required)

St. Vincent DePaul Motel to Home

Vincentian caseworker

Other

Who is your Motel to Home Caseworker?(Required)

Do you have a preferred area where you want to live?(Required)

How many adults are in your household?(Required)

How many children in your household?(Required)

Ages of children

Leave blank if no children

Do you or anyone in your household identify as a senior (55+)?(Required)

Yes

No

Do you have any pets in your household?(Required)

Yes

No

Number of pets and breeds of pets

Do you have a voucher or a subsidy?(Required)

Yes

No

Do you have a stable job or source of income that would allow you to maintain a lease agreement and pay your rent on time?(Required)

Yes

No

How long have you had this employment?(Required)

How much is your gross monthly income?(Required)

How much is your net monthly income?(Required)

Have you completed the Income and Expense Worksheet to identify how much rent you can afford?(Required)

Yes

No

(If not, please complete it and share it with your Motel to Home caseworker).

Have you previously rented?(Required)

Yes

No

Do you have previous eviction(s)?(Required)

Yes

No

How many previous evictions?(Required)

What state and county were they in?(Required)

What are the dates of your evictions?(Required)

Do you owe any collections for an eviction?(Required)

Yes

No

If yes, how much do you owe in collections?(Required)

Are you able to put the utilities in your name?(Required)

Yes

No

Do you owe any money to a utility company?(Required)

Yes

No

Does anyone in your household have a felony within the past 5 years?(Required)

Yes

No

Are you already working with a real estate agent?(Required)

Yes

No

Newsletter

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Name

This field is for validation purposes and should be left unchanged.

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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Who We Are
What We Do
Get Involved
Ways To Give
The Guardian Society
Members
Get Help

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St. Vincent de Paul

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