Housing Request

Pre-screening request

Angel House serves men 18 and older. This takes about three minutes. We only ask what we need to call you back and see whether Angel House is a fit. The full application is completed in person at your intake appointment, with a staff member walking you through it.

Please do not send Social Security numbers, ID numbers, medical records, or medication lists through this form. We will collect those at intake. If you would rather talk to a person right now, call (463) 226-7500.

About youFull name required

Date of birth requiredPhone required

EmailCity, state, ZIP

Best way to reach you

Your situationWhere are you staying right now? requiredWhen would you need a bed?Are you currently on probation, parole, or in a court-ordered program?

A criminal record does not disqualify you. We review every application individually. Details are discussed at intake, not here.

IncomeAbout how much do you bring in each month?If your income has not started yet, what is your plan for the $750 monthly fee?

How you found usHow did you hear about Healing Haven Home?

Referrer name and organizationReferrer phone or email

May we contact them about your request?

AcknowledgmentWhat I have written here is true and accurate to the best of my knowledge.I understand this is a request for contact, not an offer of housing, and that admission requires a completed intake and an individualized eligibility review.I understand the full application, the Licensee Agreement, and the House Rules are reviewed and signed in person before move-in.

Type your full name requiredToday's date required

Healing Haven Home LLC does not discriminate on the basis of race, color, religion, sex, national origin, familial status, or disability. Questions? healinghavenhome@pm.me