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Get Support

Start Your Journey to a New Beginning

Complete this registration form to begin receiving support services. All information is confidential and will be used only to provide you with the best possible assistance.

100% Confidential 24-48 Hr Intake Response Transitional Beds Available

Download Official Printable Documents (PDF)

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RESIDENT APPLICATION RESIDENT AGREEMENT RE-ENTRY PROGRAM CHECKLIST THE HOUSE RULES

💡 Completed paper applications may be mailed, emailed to intake@vitalsignsreentry.org, or submitted electronically below.

Personal Information

Your core identity and contact coordinates

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

mm/dd/yyyy

Current Address

If you currently don't have a housing arrangement leave blank

Street Address

City

State

ZIP Code

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Background Information

Release timeline and GDC details

Most Recent Release Date

mm/dd/yyyy

GDC Number (if applicable)

Current Living Situation *

Employment Status

Education Level

Additional Information

Personal accommodations and aspirations

Special Needs or Medical Conditions

Personal Goals and Aspirations

How did you hear about us?

Terms and Conditions

Required authorizations

I agree to the terms and conditions of Vital Signs Re-entry Ministry. I understand that services are provided based on availability and program requirements. I consent to background checks and verification of information provided.I consent to background checks and verification of the information I have provided. I understand this is necessary for program participation and housing placement.

By submitting this form, you agree to our privacy policy and terms of service.

Need Urgent or Same-Day Re-entry Assistance?

If you were released today and have no place to sleep tonight, reach our crisis coordinator immediately.

Call 1-877-720-4246