Skip to main navigation Skip to content

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

Facebook Twitter YouTube Instagram LinkedIn Donate

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

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*

First Last

Please provide the name and address of the current hotel you are staying at.*

How long have you stayed at a hotel?*

This field is hidden when viewing the form

What is your current living situation?*

If other, please provide details*

Have you been approved for housing?*

Yes

No

If yes, how much are move in costs?*

If you are approved for housing, what is the address of where you are moving to?

Street Address Address Line 2 City State ZIP Code

Do you have a housing voucher?*

Yes

No

If yes, where was it issued from?

Primary Phone*

Email*

Enter Email Confirm Email

Gender*

Date of Birth*

Month

Day

Year

Ethnicity*

American Indian/Alaskan Native

Asian

African American

Caucasian

Hispanic/Latino

Native Hawaiian/Pacific Islander

Unknown

This field is hidden when viewing the form

(IGNORE THIS) Deprecated Children U18

List the number of children under 18 in your household*

Please enter a number greater than or equal to 0.

Marital Status*

How long have you lived in Georgia?

In what area would you like to look for housing?*

Spouse

Name

First Middle Last

Children and Other Occupants

How many children in household?*

Are your school-aged children enrolled in school?

Do you have childcare?

Are there others in household (not dependent children)?*

Please list first and last name, date of birth and gender for each additional member in your household. (Do not include dependent children here. You can enter their information later.)

Child 1

Name

First Last

Date of Birth

Month

Day

Year

Name of School Attending

Child 2

Name

First Last

Date of Birth

Month

Day

Year

Name of School Attending

Child 3

Name

First Last

Date of Birth

Month

Day

Year

Name of School Attending

Child 4

Name

First Last

Date of Birth

Month

Day

Year

Name of School Attending

Child 5

Name

First Last

Date of Birth

Month

Day

Year

Name of School Attending

Child 6

Name

First Last

Date of Birth

Month

Day

Year

Name of School Attending

If you have more than 6 children living in your household, please finish listing out the rest of the names below:

Residency History

Prior to staying in this extended stay, where did you live?

City, State or County

How long have you stayed in extended stay motels?

0-90 days

3-6 months

6 months-1 year

1-2 years

3+ years

How many times have you been evicted from housing as an adult?

Do you have unpaid rent or utility bills in your name?

What is your credit score?*

If credit score is unknown, sign up at Credit Karma to receive a free credit report.

This field is hidden when viewing the form

(IGNORE THIS) Deprecated Credit Score

Criminal Background

Have you ever been convicted of one or more misdemeanor(s)?

Have you ever been convicted of a felony?

Are you currently on probation?

Are you currently on parole?

Other Information

Are you a veteran?*

Do you have physical health or abilities issues?

Do you seek referrals to mental health care?

What is the highest level of education you have received?

Is English your second language?

What is your primary language?

Do you have a working car or other reliable transportation to get to work?

Do you have regular income from any of the following types of employment?

Are you currently receiving social security or disability?

If yes, how much social security or disability assistance do you receive each month?

Are you currently receiving child support from an ex?

If yes, how much child support do you receive each month?

Are you currently receiving food stamps?

Are you currently receiving financial assistance from a local nonprofit?

If yes, how much financial assistance do you receive from the local non profit and what is the assistance for?

How much is your household income each month?*

Please enter a number greater than or equal to 0.

Include all income, employment, SSDI, child support, etc. Any cash income should be included.

This field is hidden when viewing the form

(IGNORE THIS) Deprecated Income

How much do you pay each month at your extended stay?*

Please enter a number greater than or equal to 0.

This field is hidden when viewing the form

(IGNORE THIS) Deprecated Extended Stay Cost

Do you have a checking account?

What bank do you have a checking account with?

Do you have financial debts (loan, cc, car payments, etc)?

Are you willing to work 1 on 1 with a caseworker for one year with the goal of maintaining stable housing?

Are you willing to attend workshops on budgeting, etc.?

Are you willing to complete periodic surveys to assess your housing progress?

What is your opinion of your living situation?

Are you in need of food?

Do you have health insurance?

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.

Signature*

Email

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

Newsletter

We'll keep you in the loop about all of our latest news, programs and ways to get involved.

"*" indicates required fields

First Name*

Last Name*

Email*

Zip Code*

Areas of Interest

Neighbor Resources

Volunteer Opportunities

Vincentian News & Updates

Donor and Impact News & Updates

Phone

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: (770) 687-2610

info@svdpgeorgia.org

Donations: gifts@svdpgeorgia.org

Facebook Twitter YouTube Instagram LinkedIn

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

Forbes

Charity Navigator: 4 Stars

St. Vincent de Paul

Copyright © 2025. All Rights Reserved. St. Vincent de Paul Georgia.

Terms of Use
Privacy Policy