Housing Request Form

  • In addition to your prom registration, please complete the following form below carefully by April 29th.
  • Each teen requesting a place to stay must complete this form, individually.
  • We will make every effort to house as many teens as possible, however, supply is limited and it will be first come first serve.
  • Please contact Tia Heard at tjheard17@gmail.com with questions or concerns.
Name *
Phone *
*Based on necessity not preference. Write "none" if not applicable.
Parent Name *
Parent Name
Parent Phone *
Parent Phone