Emergency Shelter Signature Form

Confidentiality/Release of Information
Applicant 1 Name:*
First Last
Applicant 2 Name:
First Last
Address*
Street Address Address Line 2 City State ZIP Code
County:*
Phone 1:*
Phone 2:
Applicant Email Address:*
Email Address 2:
Statement of Confidentiality
It is the policy of the Program to treat your records as confidential and not disclose them, without your written authorization, subject to certain disclosures that are permitted or required by law. This means that confidential information will not be disclosed (even to family or household members) without your authorization. In an effort, though, to provide all the services for which you are eligible, it is necessary that we have your authorization to release information to other participating agencies/entities/persons involved in providing Program services to you. This information may be entered into a computer database that other social service agencies are able to access. Program services will be contingent on the Program’s ability to share information with these other agencies/entities/persons.
Authorization*
I understand that confidential information may be shared with other agencies/entities/persons, and that such agencies/entities/persons may share confidential information with Family Gateway, for the purpose of providing program services.
Emergency/Alternate Contact
In the event of an emergency, or in the event that the Program is unable to contact me, I authorize the Program to contact the person below:
Emergency Contact Name:*
First Last
Emergency Contact Address:
Street Address Address Line 2 City State ZIP Code
Emergency Contact County:
Emergency Contact Phone 1:*
Emergency Contact Phone 2:
I authorize the Program service provider to contact me:*
- Select All
- By mail
- By phone 1
- By leaving a message on my phone 1 answering machine
- By phone 2
- By leaving a message on my phone 2 answering machine
- I authorize the Program service provider to identify itself by name.
Other instructions for Program service provider, if applicable:
E-Signature Acknowledgment*
I understand that typing my name below and throughout this contract serves as a legally binding digital signature.
E-Signature of Applicant 1 (please type first & last name):*
E-Signature of Applicant 2 (please type first & last name) if applicable:
Date:*
MM slash DD slash YYYY
City of Dallas ESG Program: Declaration of Homelessness
I certify and acknowledge that the information provided here will be used to determine my eligibility and amount of assistance and that the information is true and correct to the best of my knowledge. This information is subject to verification, and falsification of this information may be grounds for termination from the program and result in prosecution under federal and state laws.
Applicant 1 Name:*
First Last
Applicant 1 Social Security Number:*
Applicant 1 Date of Birth:*
MM slash DD slash YYYY
Today's Date:*
MM slash DD slash YYYY
Applicant 2 Name:
First Last
Applicant 2 Social Security Number:
Applicant 2 Date of Birth:
MM slash DD slash YYYY
I certify that: My household is “homeless”, as an individual or family who meets one of the following categories. Select the category that best describes your situation.*
- Residing in a place not meant for human habitation (streets, cars, parks, sidewalks, abandoned buildings)
- Residing in homeless shelters or treatment program
- Being discharged within a week from an institution or a jail/prison in which the person has been a resident for 90 days or less and no subsequent residence has been identified and lacks the resources and support networks needed to obtain housing
- Will imminently lose primary nighttime residence: (a) Being evicted within 14 days from aprivate dwelling unit, AND (b) No subsequent residence has been identified, AND (c) Lacks the resources and support networks needed to obtain housing
- Unaccompanied youth under 25 years of age, or families with children and youth, who do not otherwise qualify as homeless under HUD definition, but who: (a) Are defined as homeless under the other listed federal statutes, AND (b) Have not had a lease, ownership interest, or occupancy agreement inpermanent housing during the 60 days prior to the homeless assistance application; AND (c) Have experienced persistent instability as measured by two moves or more during the preceding 60 days; AND (d) Can be expected to continue in such status for an extended period of time due to special needs or barriers.
- (a) Fleeing a domestic violence housing situation, AND (b) No subsequent residence has been identified and (c) lacks the resources and support networks needed to obtain housing
E-Signature of Applicant 1 (please type first & last name):*
E-Signature of Applicant 2 (please type first & last name) if applicable:
Date:*
MM slash DD slash YYYY
Request for Shelter Agreement
The purpose of Family Gateway Center is to provide comprehensive services to families who want to attain and maintain stable residence in the Dallas/Collin Counties or immediate surrounding areas. Our services include temporary shelter and assistance in obtaining stable housing, income, and resources that will assist maintain self-sufficiency. Within the first week of your stay at Family Gateway, your family will be required to meet with a member of the Case Management Team. The purpose of this session and those that follow are to establish Housing Stabilization Plans, complete assessments, gather background information, and discuss how to overcome barriers and establish goals that will assist your family transition from Family Gateway Center as soon as possible. Your signature below indicates that you understand that these goals, meetings and your active participation in the program is your request for shelter and is a condition of your stay at Family Gateway Center. My signature below certifies that I agree to be an active participant in my housing plan. Furthermore, my signature certifies that I have read and understand the Welcome Packet, and agree to abide by the rules therein in order for my family to stay at the Family Gateway Center, and have been given a copy for later reference.
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Personal Possessions
The following are some quick references when you are planning to enter or leave Family Gateway: 1) If your personal possessions cannot hang up in the closet provided or fit into the drawers provided, you will have too many items forproper maintenance of your room at Family Gateway. You will be expected to store the additional items at another location,purchase bins or not bring those items into Family Gateway. 2) Your room will be clean when you enter Family Gateway – it is expected it will be clean when you leave. Make sure you have cleaned and removed all of your personal possessions from your room upon leaving Family Gateway. 3) In the event you need to leave some personal possessions behind after you leave, you will be expected to pick them up within 24 hours of leaving. After 24 hours all items will be donated or discarded. My signature below signifies that I have read and understand the information provided in the document entitled Personal Possessions. I agree to abide fully according to the provisions, as stated.
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Release of Liability - Housing
I/we acknowledge that my/our family will be Guests of Family Gateway. In consideration of being permitted to reside at the Family Gateway Center, we (myself and all individuals enrolled in the program with me), intend to be legally bound and hereby acknowledge and agree to the following:
Acknowledgment of Risk or Injury Possibility
As a participant in the program, I/we recognize the risk and acknowledge that there are certain risks of physical injury – including death, damages, property damage, or loss – which we may sustain as a result of residing at Family Gateway and/participating in any and all activities connected with the program, or the use of the facilities or equipment.
Waiver of Claim for Injury Clause
We, myself and all individuals enrolled in the program with me, agree to waive and relinquish all claims that we may have for injuries or damages as a result of residing in/participating in Family Gateway and it’s programs, activities or using the facilities or equipment, against its officers, agents, servants, employees, board of directors, volunteers, and affiliates.
Release from Liability Clause
I do hereby release and discharge Family Gateway and its officers, agents, servants, employees, board of directors, volunteers and affiliates from any and all claims for injuries, including death, damages, property damage, or loss which may have or may in future accrue to me in account of participating in or volunteering for the nonprofit organization.
Idemnity & Defense Clause
I further agree to indemnify and hold harmless and pay defense costs and defend the nonprofit organization and its agents, servants, employees, other volunteers, and affiliates, from any and all claims resulting from injuries – including death, damages, property damage, or loss – sustained by me and arising out of, connected with, or in any way associated with the activities of the program or the use of facilities or equipment.
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Release of Liability - Transportation
I, acknowledge authorize Family Gateway staff/interns and agents/outside agencies transporting on behalf of Family Gateway to transport myself and any of the individuals below:
List names, ages, and dates of birth for individuals here.*
Transportation Acknowledgment 1*
I agree.
I understand that if myself or any of the individuals listed above do not adhere to the transportation policies & regulations put forth by Family Gateway staff, interns or agents/outside agencies transporting on behalf of Family Gateway that I may lose transportation privileges in the future.
Transportation Acknowledgment 2*
I agree.
I, also acknowledge that transportation involves an element of risk, and I assume all risks and hazards incidental to such participation.
Transportation Acknowledgment 3*
I agree.
I, do hereby release, absolve, indemnify, and agree to forever hold harmless Family Gateway, its insurers, employees, and representatives from any and all financial responsibility for any injury, illness, or death as a direct or indirect result of the transportation that is provided.
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Reporting Abuse & Neglect
Family Gateway is a NO PHYSICAL DISCIPLINE shelter. In addition to this, Family Gateway and staff have the obligation to report any suspicion or allegation of abuse and/or neglect by you, of your children or any other children residing at Family Gateway Center. You will be reported immediately and without question, if any allegation is made or anyone observes abuse and/or neglect. Abuse and/or neglect will be reported in one of two ways. The Shelter/Center Director or witnessing staff will call the Abuse Reporting Hotline at (800) 252-5400 or a report will be made on-line at the Texas Department of Family and Protective Services website. In the event of an investigation by the Texas Department of Family and Protective Services or any other state agency, Family Gateway will cooperate fully with the investigative authority, up to and including the notification of law enforcement agencies assigned to the nature of the infraction. Please view the PDF packet for ideas of what constitutes abuse and neglect.
Acknowledgment of Receipt*
I have read and understand the information provided above on reporting abuse & neglect.
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Consent for the Taking and Use of Photographs, Tape Recordings, Television, Web/Internet Film and Motion Pictures
I/we understand that there will be several times during my stay at Family Gateway that there will be activities where photographs, video recordings, media, and/television may be present. I also understand that I am able to revoke this permission with respect to materials, photographs, pictures, programs or recordings which have not already been created by a notice in writing delivered to the Family Gateway of such revocation. Please make your selection below.
Consent to Photograph
I/we therefore GRANT Family Gateway permission to use any likeness, recordings of voices, or quotes for promotional material for Family Gateway, its web pages, social media accounts, newsletter, or magazine, newspaper articles, or other material written about Family Gateway of myself/ourselves and the children that I am the parent/guardian, which are listed below:
List names, ages, and dates of birth of all individuals consented to photograph below.
E-Signature of Guest 1 (please type first & last name):
E-Signature of Guest 2 (please type first & last name):
Date:
MM slash DD slash YYYY
OR Decline of Photography
I/we understand that there will be several times during my stay at Family Gateway there will be activities where photographs, video recordings, media, and/television may be present and DECLINE Family Gateway’s permission to use utilize any likeness of my camper’s, recordings of their voices, or quotes for promotional material for Family Gateway, its web pages, social media accounts, newsletter, or magazine, newspaper articles, or other material written about Family Gateway.
E-Signature of Guest 1 (please type first & last name):
E-Signature of Guest 2 (please type first & last name):
Date:
MM slash DD slash YYYY
Acknowledgment of Welcome Packet
By signing below, I acknowledge that I have received, read & understand the information included in the Welcome Packet to the Annette G. Strauss Family Gateway Center. I agree to participate in the program through case management & vocational intervention, abide by the rules, follow schedules and perform responsibilities for successful involvement in the Family Gateway Program. Furthermore, I acknowledge that I may be asked to move out of the Family Gateway Center if, in fact, I do not abide by the conditions, information and rules stated therein.
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Acknowledgment of Orientation Attendance
By signing below, I acknowledge that I have attended orientation with Family Gateway staff.
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Educational Release of Information
I/we am/are the parent(s) and/ or legal guardian(s) for the child(ren) below. As the parent/guardian of the children listed below, I, do hereby give Family Gateway Center full authorization to verify the attendance of my child(ren) on a and discuss school related information such as immunizations, behavior, suspensions, homework assignments, etc., while we are Guests of any of Family Gateway’s programs.
Please list names, ages, grades, and school for all children.*
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Involuntary/Voluntary Program Exits, Family Gateway Emergency Shelter Guest Handbook, Expectations, & The Violence Against Women Act
I have downloaded and reviewed the full PDF packet, including the Involuntary/Voluntary Program Exits, Family Gateway Emergency Shelter Handbook, Expectations, and The Violence Against Women Act on pages 16-35.
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Enrollment Services & Assessment
Part 1: Basic Information
Applicant 1 Name:*
First Last
Applicant 2 Name:
First Last
Best Phone:*
Alternate Phone:
Part 2: Homelessness
Zip Code of last permanent housing:*
Where did you and your family stay last night? Choose one only.*
- Place not meant for habitation (car, tent, outside)
- Emergency shelter (including motel paid for by program/agency)
- Transitional shelter
- Safe haven
- Hospital (non-psychiatric), and was homeless prior to admission
- Psychiatric hospital, and was homeless prior to admission
- Substance abuse inpatient, and was homeless prior to admission
- Jail, prison, or juvenile detention, and was homeless prior to incarceration
- Fleeing domestic violence
- Permanent housing (City Gate, Lake Whatcom Tx Center) and facing eviction
- Rental by client without subsidy and facing eviction
- Rental by client with VASH subsidy and facing eviction
- Rental by client with other non-VASH subsidy and facing eviction
- Staying with family and facing eviction
- Staying with friends and facing eviction
- Owned by client w/out subsidy and facing foreclosure or has been condemned
- Owned by client with subsidy and facing foreclosure or has been condemned
- Hospital (non-psychiatric), and no place to go
- Psychiatric hospital, and no place to go
- Substance abuse inpatient, and no place to go
- Jail, prison, or juvenile detention, and no place to go
- Exiting foster care home or foster care group home, and no place to go
- Staying with family, unstable situation
- Staying with friends, unstable situation
- Hotel/motel paid for by client
How long have you and your family been staying at the type of place where you stayed last night?*
- 1 week or less
- Over 1 week, less than 1 month
- 1 to 3 months
- Over 3 months, less than 1 year
- 1 year or longer
Have you been continually homeless for a year or more?*
- Yes
- No
How many times have you been homeless in the past 3 years?*
- 0-3 times
- 4+ times
Additional notes about where you stayed in the last month, year, etc.
Reasons for homelessness or risk of homelessness (select all that apply).*
- Alcoholism
- Displacement
- Health problems
- Illness
- Mental health issues
- Substance abuse
- Domestic Violence
- Eviction
- Primarily economic reasons
- Criminal record
- Out of home youth
- Family crisis
- Don't know
- Other
If "Other", please describe below.
Part 3: Household Resources
Please record your household’s income from the last thirty days in the box below. List household member, income source, and income amount.*
Include any income from these sources: Earned income, unemployment insurance, Supplemental Security Income (SSI), Social Security Disability Income (SSDI), Veteran's disability payment, private disability insurance, worker's compensation, TANF, general assistance, Social Security retirement income, Veteran's pension, pension from a former job, child support, alimony or other spousal support, etc.
Total Household Monthly Income:*
Are any of the adults in the household employed?*
- Yes
- No
If yes, list household member, workplace, # of hours worked, and if the job is permanent, temporary, or seasonal.
Is anyone in the household looking to gain employment or increase work hours?*
- Yes
- No
If yes, list household member here:
Please identify which non-cash benefits the household has received in the last thirty days. Check all that apply.*
- Food stamps
- MEDICAID - Medical Assistance
- Medicare
- TX health care for children
- Veterans Admin (VA) medical services
- Private health insurance
- Earned Income Tax Credit
- TANF child care services
- TANF transportation services
- WIC
- Other TANF-funded services
- Section 8, public housing, or rental assistance
Have you received services or are you currently working with any other service providers? (check all that apply)*
- DHA or other PHA (Housing Authority)
- CPS
- Work Force
- Veterans Administration
- Other
If "Other", please describe.
Part 4: Household Needs
For the questions below, please list household members, the condition, and any services or treatment for each category.
Does anyone in the household have a developmental disability (i.e. ADD/ADHA, dyslexia, autism)?
Does anyone in the household have a mental health problem (i.e. anxiety, depression, schizophrenia, PTSD)?
Does anyone in the household have a CURRENT alcohol abuse problem?
Does anyone in the household have a CURRENT drug abuse problem?
Does anyone in the household have a physical disability (i.e. visual/hearing impairment, head injury, mobility impairment)?
Does anyone in the household have a chronic health condition (i.e. heart disease, severe asthma, diabetes, arthritis, cancer, epilepsy)?
Are you currently employed?*
- Yes
- No
If yes, where and how long have you been working in your position?
If no, do you feel you are ready to go to work at this time?
- Yes
- No
If no, why not?
If you are looking for a job, what type do you want?
- Temporary
- Permanent
- Seasonal
- Full-time
- Part-time
- Volunteer
- Anything
What barriers do you have in finding or maintaining a job? Select all that apply.*
- Child care
- Training
- Transportation
- Housing
- Getting along with others
- Interview skills
- Substance use/abuse
- Education
- Felony
- Legal status
- Language
- Lack of work experience
- Poor work history
- Physical health issues
- Mental health issues
- None
- Other
If "Other", please describe.
Have you received any assistance with your barriers?*
- Yes
- No
If yes, what?
Are you currently in school or in a training program?*
- Yes
- No
If yes, where and in what field?
Are you interested in pursuing an education or training program?*
- Yes
- No
If yes, in what?
Do you have any other training or skills?*
- Yes
- No
If yes, specify below.
Are you working with any other agencies on employment or educational goals? If so, who?
Anything else you would like to include regarding employment or educational goals?
Would you be interested in participating in the following services? Check all that apply.*
- Mainstream Benefit Assistance
- Budgeting Class
- Financial Assistance
- Children's Education
- Domestic Violence Education
- Employment Assistance
- GED Options
- Life Skills
- Medical/Dental Assistance
- Parenting Class
- Tutoring
- After School Care
- Child Care
- Recreational Activities
- Transportation Assistance
- Mental Health Services
- Legal Services
- Educational Services
- Family Counseling
- Meals
- Laundry
- Credit Repair Services
- Clothing
- Basic Necessities
- Furniture
- Substance Abuse Services
- Other
If other services, describe below.
Have you ever rented or owned an apt/house?*
- Yes
- No
Have you ever received a pay-or-vacate notice?*
- Yes
- No
Have you ever received an eviction notice?*
- Yes
- No
Do you owe money to a previous landlord?*
- Yes
- No
If yes, how much?
Are you making payments?
- Yes
- No
Have you ever been in a subsidized housing program through any Housing Authority? (Public Housing, Sec 8, S+C, Project-Based, etc)*
- Yes
- No
If yes, when and where?
Have you ever been evicted by any Housing Authority?*
- Yes
- No
Do you owe any money to any Housing Authority?*
- Yes
- No
If yes, how much?
Have you filed appeals?*
- Yes
- No
Are you making payments?*
- Yes
- No
Housing Assessment Tool
How many people do you anticipate living in your household?*
What is the minimum unit size acceptable for your family?*
Has your child received Child Protective Services in the last 12 months?*
- Yes
- No
Reunification (through state) pending?*
- Yes
- No
If yes, what is the due date?
Could you get a positive landlord reference?*
- Yes
- No
How many times have you been evicted/foreclosed on a house or you were asked to leave your housing?*
Do you have any debt to any utility companies?*
- Yes
- No
If yes, estimate how much you owe to utilities:
What is the estimated level of debt for your household (such as credit cards, hospital, car debt, and others)?*
Is your family interested in being referred to programs that specialize in serving persons with chemical dependency?*
- Yes
- No
Is your family interested in being referred to programs that specialize in serving persons with mental health/behavioral health needs?*
- Yes
- No
Is your family interested in being referred to programs that specialize in serving immigrants and refugees?*
- Yes
- No
Is your family interested in being referred to programs that specialize in serving persons from a specific cultural background?*
- Yes
- No
If yes, please indicate below.
Is your family interested in being referred to programs that specialize in serving survivors of domestic violence?*
- Yes
- No
Is your family interested in being referred to programs that specialize in employment and education services?*
- Yes
- No
Is your family interested in being referred to a program that requires someone in your household to have a disability?*
- Yes
- No
Does your family have any special accommodation needs (i.e. first floor apt, ramps, elevators, other)?*
- Yes
- No
If yes, please describe below.
Do you have a geographic presence? If yes, describe below.
If the housing option is not in this area, are you interested in other locations? Please describe below.
Do you require confidential housing due to safety concerns?*
- Yes
- No
In the case of domestic violence or other situations, which area(s) are unsafe?
Do you have a family pet?*
- Yes
- No
Is there anything else you would like us to know regarding your housing needs?
E-Signature of Guest 1 (please type first & last name):*
E-Signature of Guest 2 (please type first & last name):
Date:*
MM slash DD slash YYYY
Texas Department of Housing & Community Affairs: Certification of Zero Income
Part A*
I hereby certify that:
I do not individually receive income from any of the following sources:
• Wages from employment (including commissions, tips, bonuses, fees, etc.);
• Income from operation of a business;
• Rental income from real or personal property;
• Interest or dividends from assets;
• Social Security payments;
• Supplemental Security Income payments;
• Payments from annuities, insurance policies, retirement funds, pensions, or death benefits;
• Unemployment or disability payments;
• Public assistance payments (other than food stamps);
• Periodic allowances from alimony or child support;
• Gifts received from persons not comprising the household;
• Sales from self-employed resources (Avon, Mary Kay, Pampered Chef, Shaklee, etc.);
• Any other source not named above; AND
Part B*
I hereby certify that:
I currently do not have income of any kind and there is no imminent change expected in my financial or employment status during the next 12 months; AND
I will be using the following sources of funds to pay for rent, utilities, and/or other necessities:*
Applicant Certification
Under penalty of perjury, I certify, to the best of my knowledge, that the information presented in this certification is true and accurate. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of participation under a Texas Department of Housing and Community Affair’s (THDCA) Affordable Housing Program.
Household/Resident 1 E-Signature (please type first & last name):*
Household/Resident 2 E-Signature (please type first & last name):
Date:*
MM slash DD slash YYYY
Declaration of Income Statement
Applicant 1 Name:*
First Last
Applicant 2 Name:
First Last
Address*
Street Address Address Line 2 City State ZIP Code
State the gross income for household members, 18 years and older, who have no documentation of the income received in the 30 day period prior to the date of application for assistance:*
My household has no documented proof of income due to the following situation:
Attestation*
I certify that the above information is true and correct to the best of my knowledge and belief. I understand that the information will be verified to the extent possible; and that I may be subject to prosecution for providing false or fraudulent information.
Head of Household E-Signature (please type first & last name):*
Spouse/Other Adult E-Signature (please type first & last name):
Date:*
MM slash DD slash YYYY
Receipt of Violence Against Women Act Protections & Rights
VAWA was reauthorized in 2013, and provides basic protections and rights for applicants and residents receiving rental assistance. The “Notice of Occupancy Rights under the Violence Against Women Act” based on HUD form 5380, and the “Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking,” HUD form 5382, must be provided to applicants of and Program Participants in the ESG Program. I have received, read, and understand the “Notice of Occupancy Rights under the Violence Against Women Act” and “Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking” (HUD Form 5382). Please download and review the Notice of Occupancy Rights Under the Violence Against Women Act PDF.
Applicant 1 E-Signature (please type first & last name):*
Applicant 2 E-Signature (please type first & last name) if applicable:
Date:*
MM slash DD slash YYYY

Emergency Shelter Signature Form

Confidentiality/Release of Information

Statement of Confidentiality

Emergency/Alternate Contact

City of Dallas ESG Program: Declaration of Homelessness

Request for Shelter Agreement

Personal Possessions

Release of Liability - Housing

Acknowledgment of Risk or Injury Possibility

Waiver of Claim for Injury Clause

Release from Liability Clause

Idemnity & Defense Clause

Release of Liability - Transportation

Reporting Abuse & Neglect

Consent for the Taking and Use of Photographs, Tape Recordings, Television, Web/Internet Film and Motion Pictures

Acknowledgment of Welcome Packet

Acknowledgment of Orientation Attendance

Educational Release of Information

Involuntary/Voluntary Program Exits, Family Gateway Emergency Shelter Guest Handbook, Expectations, & The Violence Against Women Act

Enrollment Services & Assessment

Part 1: Basic Information

Part 2: Homelessness

Part 3: Household Resources

Part 4: Household Needs

Housing Assessment Tool

Texas Department of Housing & Community Affairs: Certification of Zero Income

Applicant Certification

Declaration of Income Statement

Receipt of Violence Against Women Act Protections & Rights