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Transitional Housing Application

We are only accepting emergency placement applications at this time.
 

Please complete all sections. Incomplete applications may delay review. Submission does not guarantee placement.

Section 1: Referral Information

Are you currently involved in or placed through any of the following systems? (Check all that apply)
** Is this a referral by another agency?
Yes
No
If immediate placement is not available do you wish to be place on the waiting list?

Section 2: Applicant Information

First and Last Name

Birthday of Applicant
Month
Day
Year

Section 3: Eligibility Screening

Please check YES or NO for each question.

Are you currently a resident of Kingsport, Tennessee? (Please note: We do not provide interstate transfers.)
Yes
No
I understand this facility only provides transitional housing and mentorship to youth ages 15-26
Yes
Are you currently under the age of 18?
Yes
No
Are you willing and able to participate in a structured mentorship program as a condition of housing?
Yes
No
Are you willing to participate in mentorship, house rules, school or court requirements, and support meetings?
Yes
No
** Does the applicant have any children?
Yes
No

Section 4: Program Information

Participant Needs and Goals

Resident Responsibilities and Program Terms

Living in a communal environment requires residents to consistently demonstrate respect, discretion, and consideration for staff, volunteers, and fellow residents. This includes respecting others’ privacy, keeping personal matters personal, and adhering to all program rules and schedules. The program has a maximum duration of 24 months, designed to provide sufficient time for personal growth, skill development, and preparation for independent living. Exceptions are made for participants under 18 or those placed in independent living programs through the state, foster care, or juvenile court systems, and residents who demonstrate readiness may graduate in as little as 3 months.

Residents who remain in the transitional program beyond the initial 90 days are required to maintain valid identification, current medical insurance, and comply with the approved sliding rent fee schedule.

What personal goals would you like to work toward during the program? (Check all that apply)
What types of support do you believe would help you most during the program? (Check all that apply)
What best describes your current educational status?
Do you feel you need support in any of the following areas?
Have any of the following impacted your housing or well-being?
Are there behaviors you are currently working to improve?
Are you currently receiving support services from another agency or program?
Yes
No
Are you currently in a safe living environment?
Yes
No

Section 5: Program Acknowledgment

  •  I understand this is a transitional housing program with a maximum duration of 24 months.

  • I understand participation in mentorship, meetings, and program activities is required.

  • I certify that all information provided is true and accurate to the best of my knowledge.

  • I understand that housing placement is not guaranteed.

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Temporary Address:

 

Restoration Hope

3812 Memorial Blvd. Suite 3

Kingsport, TN 37664

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Mission Statement:
REACH one, then TEACH one, until we RESTORE one!

Our Mission: 

Restoration Hope aims to cultivate hope and healing through our educational and workforce-driven programs.

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