Application

Please note: We are not an emergency shelter therefore unable to take families in without a phone intake with case manager and scheduled face-to-face interview. Please give our case manager at least 24 hours to call and complete phone screening.

Step 1 of 3

Parent/Guardian Name(Required)

First Last

Phone(Required)

Current County(Required)

Today’s Date(Required)

How many adults in your family?(Required)

How many children in your family?(Required)

Are your children school-aged?(Required)

Yes

What school(s) do your children attend?(Required)

Adults

Please list adult's age and relationship

Adult 1 Age(Required)

Adult 1 Relationship(Required)

Adult 2 Age(Required)

Adult 2 Relationship(Required)

Adult 3 Age(Required)

Adult 3 Relationship(Required)

Adult 4 Age(Required)

Adult 4 Relationship(Required)

Adult 5 Age(Required)

Adult 5 Relationship(Required)

Adult 6 Age(Required)

Adult 6 Relationship(Required)

Children

Please give children's age and gender

Child 1 Age(Required)

Child 1 Gender(Required)

Child 2 Age(Required)

Child 2 Gender(Required)

Child 3 Age(Required)

Child 3 Gender(Required)

Child 4 Age(Required)

Child 4 Gender(Required)

Child 5 Age(Required)

Child 5 Gender(Required)

Child 6 Age(Required)

Child 6 Gender(Required)

Need Assistance?

(772) 266-9327

Family Center Hours

Monday through Friday
9 AM to 4 PM

Mailing Address

P.O. Box 1919
Stuart, Florida 34995

Donate

A copy of the official registration and financial information may be obtained from the Division of Consumer Services by calling toll-free (800-435-7352) within the state. Registration does not imply endorsement, approval or recommendation by the state. #CH59005