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URM Intake Application
All guest must have a proof of ID and pass Megan’s law clearance
Name:
(Required)
First
Middle
Last
Phone Number:
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Email
(Required)
Attached identity documents (Driver License, SSC)
Drop files here or
Select files
Accepted file types: pdf, jpg, jpeg, doc, Max. file size: 512 MB, Max. files: 2.
What is your current living situation?
(Required)
Car
RV
Motel/ Hotel
Street/ Park
Other
Motel/ Hotel Check Out Date (If Applicable)
MM slash DD slash YYYY
Are you in need of immediate shelter?
(Required)
Yes
No
Other
Would you be interested in enrolling in one of our offered programs?
(Required)
Single Men
Men's Christian Life Discipleship Recovery Program
Family Emergency Services
Womens Damascus Recovery Program
Single Women
Hope Gardens Family Center Program
Angeles House Program
None
Where were you staying prior to coming to this mission?
(Required)
Friend/ Family
Streets/ Park
Shelter/ Mission
Other
If other:
How many are in your party? Please include yourself.
(Required)
Union Rescue Mission History/ Homelessness History:
Have you previously received shelter service at URM?
(Required)
Yes
No
If yes, when?
Are you currently on the waitlist for Section 8/ Public housing
(Required)
Yes
No
What services have you used in the past?
(Required)
Emergency Shelters
Hotel/ Motel Vouchers
Domestic Violence Shelter
Transitional Housing
Section 8 Housing
Do you agree to quarantine for 5 days upon arrival and be tested for covid-19?
(Required)
Yes
No
