STEP 3  Our staff will contact you 

STEP 2  Application 

Criteria for Deborah House Admission:

- Must be 18 years or older

- Must be currently pregnant or have one child or two children under the age of 5

- Must be currently employed, willing to work or have consistent monthly income

- Must be willing to contribute to monthly living expenses

- Must be willing to participate in The Deborah House program

If you do not meet the criteria 

please click the link below.

- ​APPLICATION WILL NOT SUBMIT WITHOUT PICTURE UPLOAD OF A LICENSE OR ID.*

 At the bottom of this application we will ask for an upload of your state issued ID or drivers license.*

In order to fill out the form below please have ready the following:

 

If your device is having trouble filling out this online application, please download the PDF version below and email it to director@klmcdc.org

To ensure the safety of our residents, the Deborah house requires a criminal background check for each applicant. 

STEP 1 Criteria 

In order to apply for our housing program applicants must first qualify please review  the criteria below.

 
 
The Deborah House Online Application
How did you hear about us?
Are you currently homeless or living with someone?
Are you currently pregnant?
Have you had a baby in the last two years?
How many children do you currently have?
Are you currently employed?

List all sources of income (State Assistance, Child Support, etc.)

Total Monthly Income: $

Do you currently have health insurance?
Do you have a primary doctor?
Do you have any allergies/medical problems?

Additional Information

Are you over 18 years of age or a legally emancipated minor?
Are you able to understand (verbal and/or written) English?

Please list all children that will reside with you IN the Deborah House. Please provide all requested information.

Are there any additional accommodations you would need to participate in this program? For example, wheelchair accessibility, TTY, large print or Braille, service animals, etc. You may include any information you believe is relevant to your participation in Transitional Housing.
Are you currently homeless as a result of fleeing an abusive person?
Are you currently staying in a safe place while your participation in The Deborah House Program is determined?
If No, may someone contact you about options for safe, emergency shelter?
Are you willing to relocate to another community?

Is there anything else you would like to share with us about your immediate safety concerns?

Have you ever been arrested?
Do you currently use drugs or alcohol?

Do you suffer with depression, anxiety or any other mental health issues?

Please include any other information you feel would be helpful for us when considering your application:

Please describe any questions or concerns you have about The Deborah House, which we can discuss when we meet:

References: Please list information for two (2) references that we may contact.

References 1

References 2

To complete this application. Please upload picture of state issued photo I.D or Drivers License with the matching name given on this application. 

Upload File
Max File Size 15MB

Please note that this is an application and does not constitute acceptance into The Deborah House. If you are eligible, a follow-up meeting will be scheduled and additional information may be requested. Thank you!