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Intake Application

Our support services are available for qualifying single mothers with a substance abuse and/or mental health diagnosis.

Hopeful Solutions Dallas

Intake Application

VERY IMPORTANT!
In order to qualify for our services, you MUST:
1) Be a single mother
AND
2) Either have a mental health diagnosis, a history of substance abuse, or both.
Please check all applicable choices.
Household Composition

List Head of Household and all other members who will be living in the unit. Give the relationship of each family member to the Head of Household.

Applicant Information

This information is being collected to assure compliance with Fair Housing Regulations.

1. Race/Ethnicity of Head of Household (check one)
2. Are you currently homeless or living in a shelter?
3. Have you ever been in a Section 8 rental assistance program?
If yes, please select an option:
4. Have you ever been in treatment for drug or alcohol abuse?
5. Have you ever been diagnosed with a mental illness?

Income Information

Do not include any monetary amounts on this form. We will request total amounts for each source of income after the application has been submitted. 

Upload File

I understand that my application will only receive a response if:​

I understand that my application will only receive a response if I check yes to at least one of the following options:

Application Certification

I understand that the above information is being collected to determine my eligibility to be a participant with Hopeful Solutions Dallas. I authorize Hopeful Solutions Dallas staff to verify all information provided on this application.

Thanks for submitting! We'll get back to you as soon as possible.
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