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WE ARE HERE
FOR YOU

Single mothers in Los Angeles who are interested in receiving the resources and support provided by SHE IS HOPE LA can fill out an intake form.

 

To get started, please fill out the intake form below. Once you submit the form, you will be directed to schedule a call with one of our knowledgeable and compassionate advisors, who can provide you with tailored support and advice. We look forward to connecting with you and helping your family create hope for the future. We do not provide housing, yet, please see our resources for contact information under Housing. Also see Studio City's guide for Homelessness and Reporting.

 

Thank you!

SINGLE MOTHER INTAKE FORM
Do you have a safe place to stay?
Do you have any pets?
Which ethnicity best describes you? (Please choose only one.)
What are your preferred pronouns?
What is your status?
Are you currently dating or in a reationship with anyone other than the children's father?
Anyone living in your household besides you and your children?
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Are your children in school? Check all that apply:
Are any of your children in IEP?
Do your children have any special needs?
Are you or your children in therapy?
Are you or your children a client of the LA County Regional Center?
Do you receive child support?
What is your child custody status?
Are you getting government assistance? If so, what programs?
Are you or your children in urgent need of care?
What type of transportation do you use:
Are you currently employed?
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Are you interested in any of the following:
Please indicate any special areas of need for yourself:
Have you ever been arrested or charged wth a crime?
Are you on probation or parole?
Have you ever been treated for, or diagnosed substance abuse or addiction?
Are you currently experiencing substance and/or alcohol addictions?
Are you seeking treatment or want help with substance and/or alcohol addiction?
Have you experienced physical, sexual or emotional abuse?
Are you seeking treatment or need help with physical, emotional or sexual abuse?
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