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.

Parent/Guardian Name

First Last

Phone

Current County

Today’s Date

What are your current living conditions?

Other

How did you hear about us?

Briefly describe your family’s needs

How many adults in your family?

How many children in your family?

Are your children school-aged?

Yes

What school(s) do your children attend?

Adults

Please list adult's age and relationship

Adult 1 Age

Adult 1 Relationship

Adult 2 Age

Adult 2 Relationship

Adult 3 Age

Adult 3 Relationship

Adult 4 Age

Adult 4 Relationship

Adult 5 Age

Adult 5 Relationship

Adult 6 Age

Adult 6 Relationship

Children

Please give children's age and gender

Child 1 Age

Child 1 Gender

Child 2 Age

Child 2 Gender

Child 3 Age

Child 3 Gender

Child 4 Age

Child 4 Gender

Child 5 Age

Child 5 Gender

Child 6 Age

Child 6 Gender

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