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"the movements within the movement are dedicated to creating the conditions for life, conditions that include livelihood, food, security, peace, a stable environment, and freedom from external tyranny."

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HOME • CLIENTS • PROGRAM • RESULTS • ABOUT+CONTACT • QUESTIONNAIRE • DOUG@THEDOORWAYTOSOLUTIONS.COM

Name:		Gender:	Male Female
Age:		Are you currently homeless?	Yes No
Are you Married?:	Yes No	Do you have any children?	Yes No
Reason for housing needs		Have you lived in a Community Living setting int he past?	Yes No
Your expectations of a community living enviornment		Are you currently employed?	Yes No
Rank in order of priority
Wellness, Health, and Fitness		Economic Security and Employment
Education		Entertainment
Phone Number:		Email:
Mailing Address		City / State / Zip