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Who We Are
What We Do
Thrift Store
Get Involved
- Volunteer
- Partner
News & Events
- What’s New
- Events

Need Help?

If you or someone you know is experiencing homelessness and in need of assistance, we’re here to help. Complete our application form to access our supportive services and take the first step towards a brighter future.

Guest Prescreen for Shelter

Honest answers are essential for us to serve you. We will provide referrals to community services and place you on our waiting list based on this information. Please only fill out the form once. Due to a high volume of calls it is taking longer than usual to reply to everyone. You will get a call as soon as possible.

"*" indicates required fields

Name*

Prefix First Middle Last

I am filling this out for myself

to be placed on the waiting list we need to speak to the applicant. Please make sure contact information is accurate.

yes

no

Reason I am filling this out for someone else:

DO NOT CHECK CONSENT BOXES FOR THIS APPLICATION. IF YOU ARE FILLING THIS OUT FOR SOMEONE ELSE WE NEED TO SPEAK TO THEM FOR CONSENT

English as a second langugage

Disability

Limited access to technology

(Filling out for someone else) MY name and phone number:

Maiden name or alias?

Gender

Ethnicity*

Caucasian (Non-Hispanic)

African American

Latino American

Native American

Hispanic American

Asian American

Other

Other*

Date of Birth*

MM slash DD slash YYYY

Phone

This is not my phone, this phone belongs to someone else

please tell us their name

Best way to reach you?

Email

County*

Other TN County

name of county Knox, Roane, Sevier etc.

Most recent or current address

Street Address Address Line 2 City State ZIP Code

Tell us about your family*

Family Size

How many people need shelter?

Children in your custody/household*

number of children that would be coming into the shelter with you

Please call Helpline 865-215-4211.

Family Promise only has programs that serve families with children. Helpline will help you find another program.

I need shelter because*

Other/more than one reason:

Please provide details.

Where are you staying now?*

Date you need to be out:

(date lease ends etc.)

MM slash DD slash YYYY

Have you been homeless before?*

Homeless for over one year?

This question is to collect data for state and national information only and will not keep you from getting assistance.

Have you been homeless 4 or more times in 3 years?

This question is to collect data for state and national information only and will not keep you from getting assistance.

Stayed at a Family Promise before?

This question is to collect data for state and national information only and will not keep you from getting assistance.

Are you employed?*

I am willing and able to work.

Employer

Name of employer

Sources of Income

Employment

Food Stamps

Child Support

SSI

other

Monthly Income (amount)

Child Support (amount)

SSI (amount)

other (amount)

List all Family members

Please click + to add more family members. Children, partner, anyone who is needing shelter with you.

Name

Gender

Date of Birth

Are you working with other Agencies?

School Resource, Good Neighbors, McNabb etc.

My children are enrolled in School

School System:

choose one

Did anyone refer you?

How did you find out about Family Promise? (School, case manager, 211, Google, etc. )

Anything else you want to tell us?

Pregnant (anyone in household?)

yes

no

Due Date

MM slash DD slash YYYY

Veteran (anyone in household?)

yes

no

Consent

We need to confirm your identity.

Family Promise of Blount County has my permission to run a background screening.

Program Agreement

This is a program, your participation determines the outcome.

I am willing to commit to a weekly case management program

In order to best serve you we may partner with other agencies. Family Promise of Blount County has my permission to speak to partner agencies about my case.

Yes, you may contact other agencies.

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.

Someone will call you back within business hours

Mon-Fri

8 am to 4 pm

If you need additional resources (meals, clothing, shelter etc.)

please call 211 or (865) 215-4211.

Or go to the United Way of Blount County Resource page: https://unitedwayblount.org/resources/

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Family Promise BC

865.233.4737
asmith@blountfamilypromise.org
P.O. Box 4457, Maryville, TN 37802

Second Chance Thrift Store

865.233.4737
705 E Lincoln Rd, Alcoa, TN 37701

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