Client Intake — Helping Hands Shared Housing

Your Information

Your Name *

Your Email

Your Phone

Client Information

First Name *

Last Name *

Gender

Program Eligibility

Does the client have IDD support needs?

Yes — client has Intellectual/Developmental Disability support needs

Is the client a veteran?

Yes — client is a U.S. veteran

Situation & Timeline

Brief Description of Situation

Preferred Move-In Timeline

Fields marked * are required. We'll follow up with you within 1–2 business days. For urgent placements, call us directly at (229) 376-3932.

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