Home
Services
Demographics Served
Contact

First Name *

Last Name *

Gender *

Phone *

Email *

Housing Needed *

Permanent

Transitional

Emergency

Desired Move-In Date *

Do you have a Case Manager? *

Yes

Case Manager Name

Case Manager Organization

Case Manager Phone

Case Manager Email

Have you been in jail or prison within the last 5 years? *

Yes

Charge Description

Charge Year

Release Date

Diagnosed mental health condition(s)? *

Yes

List diagnoses

Can you take medications on your own? *

Yes

Sometimes

Health Notes *

How will rent be paid? *

SSI/SSD

Non‑profit assistance

Employment

Other

Rent Payment Other Details

Proof of Income *

Benefits card shown

Permission to verify with agency

Bank statements (last 3 months)

Other

Proof of Income Other Details

Have you lived in shared housing before? *

Yes

What worked/Didn’t work?

Reason for leaving

Any challenges we should plan for? *

Budgeting/finances

Gambling

Substance use

Other

Challenges Other Details

Anything else we should know to ensure a good fit? *

Applicant Consent *

I confirm the information above is accurate and authorize verification of housing and funding information for screening.

Applicant Signature

Clear

Signature Date

How did you hear about us?

First Name *

Last Name *

Email *

Phone *

Interested In

I'm looking for housing for myself

I'm a case manager or referral partner

I'm a discharge planner or social worker

I represent a community organization or nonprofit

Other

Message

Nurture Bridge

Serving Athens and Northeast Georgia, Nurture Bridge welcomes partnerships and referrals nationwide and proudly accepts clients from across the United States.

Nurture Bridge does not discriminate in admission, continued residency, or services based on race, color, creed, national origin, age, sex, gender identity, marital status, sexual orientation, disability (including blindness), or any other status protected by law.

Nurture Bridge

Serving Athens and Northeast Georgia, Nurture Bridge welcomes partnerships and referrals nationwide and proudly accepts clients from across the United States.

Nurture Bridge does not discriminate in admission, continued residency, or services based on race, color, creed, national origin, age, sex, gender identity, marital status, sexual orientation, disability (including blindness), or any other status protected by law.

Nurture Bridge

Serving Athens and Northeast Georgia, Nurture Bridge welcomes partnerships and referrals nationwide and proudly accepts clients from across the United States.

©2026 by Nurture Bridge

Nurture Bridge

Serving Athens and Northeast Georgia, Nurture Bridge welcomes partnerships and referrals nationwide and proudly accepts clients from across the United States.

Nurture Bridge does not discriminate in admission, continued residency, or services based on race, color, creed, national origin, age, sex, gender identity, marital status, sexual orientation, disability (including blindness), or any other status protected by law.

©2025 by Nurture Bridge