Together We Can Help The Gears Turn Forward

If you are a family seeking support, we are here to help. Our comprehensive programs are designed to provide the assistance and opportunities needed to empower a brighter future for you and your family. Visit our Family Services page to find out more about how we can support you. Together, we can ensure that every child has the chance to thrive.

Please fill out the form below if your family meets the criteria for our program.

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Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.
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Need to Call Now?

Call us: 404-892-3713 and then dial 3 to learn about enrollment.
Your Name*
Please check the box to confirm you understand the following:*
If you are in search of an overnight bed or do not have a child under 5, please scroll down for a list of additional resources.
Our program will require you to have a valid ID, your and your child(ren)'s Social Security cards, your and your child(ren)'s birth certificates, and your child(ren)'s immunization records. Do you have these items?*
IT'S OKAY IF YOU DON'T! We just want to know ahead of time so we can get the process started for you to access them!
Listing the shelter, your case manager, and your case manager's phone number can help us to more efficiently coordinate care for your child.

Contact Information

We want to help! We will be asking for several forms of contact information to make sure that we can get in touch with you and get you the resources you need!
Your Primary Language

Where do you check your email?*

How often do you check your email?*
This might be a cell number. It might be a home number you regularly have access to or it might be a work extension. For any of these, please list under "Best Time to Call You" the time you are by this phone most often.
Include any information you feel comfortable sharing at this time
This field is for validation purposes and should be left unchanged.

Additional Resources

If you are in need of overnight shelter, please call:

The United Way Community Resource Hotline

211

Crossroads Atlanta

(470) 225-1995

The Gateway Center

(404) 215-6600

Are you unsafe in your home? Please call:

If you are in Atlanta:

Women’s Resource Center*

(404) 688-9436

 *will accept calls from those of all genders

If you are anywhere:

Partnership Against Domestic Violence

(404) 873-1766