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What We Do / Housing / Motel 2 Home Application

Motel 2 Home Application

"*" indicates required fields

Head of Household Information

Each person listed must match birth certificate or driver's license.
Name*
Have you been approved for housing?*
Address
Date of Birth*
Ethnicity*
You must have a child under 18 in your home to qualify.

Spouse

Name

Children and Other Occupants

Child 1

Name
Date of Birth

Children's Information

Child 1
Date of Birth
Child 2
Date of Birth

Children's Information

Child 1
Date of Birth
Child 2
Date of Birth
Child 3
Date of Birth

Children's Information

Child 1
Date of Birth
Child 2
Date of Birth
Child 3
Date of Birth
Child 4
Date of Birth

Children's Information

Child 1
Date of Birth
Child 2
Date of Birth
Child 3
Date of Birth
Child 4
Date of Birth
Child 5
Date of Birth

Children's Information

Child 1
Date of Birth
Child 2
Date of Birth
Child 3
Date of Birth
Child 4
Date of Birth
Child 5
Date of Birth
Child 6
Date of Birth

Residency History

City, State or County
How long have you stayed in extended stay motels?

Criminal Background

Other Information

Add only income from employment for all adults in the household.

Signature

By signing, the applicant represents that all of the above information is true and correct and hereby authorizes verification of the above items including, but not limited to, the obtaining of a credit report or background check. If any information is false, St. Vincent de Paul Georgia is entitled to reject the application.
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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:
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Contact
Main: (678) 892-6160
Assistance: (678) 892-6163
Pharmacy: (678) 892-6181
info@svdpgeorgia.org
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