The Elizabeth House Pre-Screening

Now accepting applications

The Elizabeth House offers safe and stable housing to pregnant homeless single women, ages of 18+. We accept first time pregnant women, women who have just given birth and expectant mothers with a child up to the age of two.

Interested in becoming part of The Elizabeth House? Take the first step by completing this form. We will respond to you within four business days.

Your name (required):
Your phone (required):
Your email (required):
Your age (required):
Are you homeless or in unstable housing? YesNo
Are you pregnant? YesNo
If so, how far along are you?
Do you have an additional child(ren) under the age of 2? YesNo
If yes, what are their ages?
Do you have alcohol or drug concerns? YesNo
If so, have you been sober for at least 6 months? YesNoN/A
Do you have a criminal background?
Note: We are not able to accept persons with neglect or abuse charges or sexual crimes. YesNo
Do you have any diagnosed mental health conditions or concerns about your mental health? YesNo

The Elizabeth House is a program of Care Net Pregnancy Center of Dane County.
Copyright 2018 | Care Net Pregnancy Center of Dane County | All rights reserved
Sitemap | Privacy Notice

Donate