Housing Intake Form

Client Information
 
Family Background/History
 
Health & Medical Information
 
Employment History
 
List status of following items:
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The above information is being provided with the permission of the applicant listed below to be
reviewed by the AbolitionNC designated care team with the sole intent of determining the
appropriateness of housing services per AbolitionNC as available. The completion of this
application does not guarantee that housing will be provided. If housing is not immediately
available, then the applicant will be notified of her placement on the AbolitionNC waiting list and
will be notified via the referral agency once placement is available. If placement is offered to the
applicant and applicant refuses placement, applicant will forfeit placement on the waiting list
and may be required to complete another application for a future placement. 
 

Thank you for contacting AbolitionNC

We have received your Housing Intake Form application and will contact you shortly.

 

Please note: 

The provided application will be reviewed by the AbolitionNC designated care team with the sole intent of determining the appropriateness of housing services per AbolitionNC as available. The completion of this application does not guarantee that housing will be provided. If housing is not immediately available, then the applicant will be notified of his/her placement on the AbolitionNC waiting list and will be notified via the referral agency once placement is available. If placement is offered to the applicant and applicant refuses placement, applicant will forfeit placement on the waiting list and may be required to complete another application for a future placement. 

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