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Housing Request Form

  • In addition to your prom registration, please complete the following form below carefully by April 27th.

  • 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 Kelly Throne at kthrone.hamptonroads@gmail.com with questions or concerns.

Name *
Name
Phone *
Phone
*Based on necessity not preference. Write "none" if not applicable.
Parent Name *
Parent Name
Parent Phone *
Parent Phone