Anne Street Village Application

Anne St. Application

Anne Street Village is an initiative from the City of Salisbury's Housing First program. Per the National Alliance to End Homelessness, the Housing First approach views housing as the foundation for life improvement and enables access to permanent housing without prerequisites or conditions beyond those of a typical renter. This approach is guided by the belief that people need basic necessities like food and a place to live before attending to anything less critical, such as getting a job, budgeting properly, or attending to substance use issues.

Name(Required)

First Last

Date of Birth(Required)

Phone number

If you do not have a phone number list a number or shelter you can be reached at

Do you currently have documentation of either of the three elligbilty requirements below? Please check all that apply.(Required)

Severe mental health diagnosis

Physical disability

Homeless for at least 1 year out of the last three years

How long have you been homeless?(Required)

Provide common locations where you can be found for intake. Please provide days and times with the location if possible. For example...."can be found at Go-Getters Monday-Friday from 9am to 11pm"

Please provide any additional comments about yourself that may be helpful

I am a resident of Wicomico County(Required)

Yes

If you are a provider referring a client, please list the following:

Agency name

Agency contact person

Agency phone number

Date