Update Your Information

This dynamic form will create new input fields depending on your services provided. Please complete the entire form before submitting.
Your information will be reviewed before being added to the GAEH Provider Map. If you have any issues please email info@gahomeless.org

Organization Name: *

Website:

Email Address: *

Phone: *

County:

Select CountyApplingAtkinsonBaconBakerBaldwinBanksBarrowBartowBen HillBerrienBibbBleckleyBrantleyBrooksBryanBullochBurkeButtsCalhounCamdenCandlerCarrollCatoosaCharltonChathamChattahoocheeChattoogaCherokeeClarkeClayClaytonClinchCobbCoffeeColquittColumbiaCookCowetaCrawfordCrispDadeDawsonDecaturDeKalbDodgeDoolyDoughertyDouglasEarlyEcholsEffinghamElbertEmanuelEvansFanninFayetteFloydForsythFranklinFultonGilmerGlascockGlynnGordonGradyGreeneGwinnettHabershamHallHancockHaralsonHarrisHartHeardHenryHoustonIrwinJacksonJasperJeff DavisJeffersonJenkinsJohnsonJonesLamarLanierLaurensLeeLibertyLincolnLongLowndesLumpkinMaconMadisonMarionMcDuffieMcIntoshMeriwetherMillerMitchellMonroeMontgomeryMorganMurrayMuscogeeNewtonOconeeOglethorpePauldingPeachPickensPiercePikePolkPulaskiPutnamQuitmanRabunRandolphRichmondRockdaleSchleyScrevenSeminoleSpaldingStephensStewartSumterTalbotTaliaferroTattnallTaylorTelfairTerrellThomasTiftToombsTownsTreutlenTroupTurnerTwiggsUnionUpsonWalkerWaltonWareWarrenWashingtonWayneWebsterWheelerWhiteWhitfieldWilcoxWilkesWilkinsonWorth

Address: *

Eligibility Requirements:

Population Served:

Single Parent

Two Parents with children

Grandparent with children

Children 0-12

Youth 13-18

Single Female Adult

Single Male Adult

Seniors

LGBT

Services Provided:

Housing

Food & Supplies

Transportation

Child Care

Medical

Counseling / Support Group

Education / Employment

Financial Help

Legal Assistance

OtherOther

Priority Services:

Domestic Violence Help

Veterans

Recovery

Recuperative Care

Please give us more details on the services you provide.

Housing:

Permanent Shelter: Affordable Housing

Permanent Shelter: Supportive / Group Home

Permanent Shelter: Skilled Nursing Facility / Nursing Home

Permanent Shelter: Assisted Living Facility

Permanent Shelter: Section 8

Temporary Shelter: Emergency – 30 days or less

Temporary Shelter: Emergency - 30+ days

Temporary Shelter: Emergency - Domestic Violence

Temporary Shelter: Emergency - Seasonal / Winter

Temporary Shelter: Emergency - Runaway Shelter

Temporary Shelter: Transitional Housing - With Supportive Services

Temporary Shelter: Transitional Housing - Without Supportive Services

Temporary Shelter: Halfway House / Recovery

Temporary Shelter: HIV / AIDS Housing

Temporary Shelter: Single Room Occupancy (SRO)

Temporary Shelter: Day Shelter / Respite

Permanent Shelter: Housing First

Permanent Shelter: Prison Re-entry

Permanent Shelter: Veterans

Permanent Shelter: Permanent Supportive Housing

Permanent Shelter: Recovery

Permanent Shelter: Families with Children

Permanent Shelter: Sex Offenders

Temporary Shelter: Assessment

Temporary Shelter: Supportive Housing

Temporary Shelter: Emergency - Inclement Weather

Food & Supplies:

Meals - On Site

Meals - Delivered / Meals on Wheels

Pantry

Sack Lunches

Food Stamps

Financial Assistance / Vouchers

School Supplies

Holiday Gifts

Baby Supplies

Transportation:

Medical

Employment

To / From Organization

Bus / Train tickets

Assistance in Obtaining Driver's License / ID

Child Care:

General / Day

Before School

After School

Summer Camp

Mentoring / Tutoring

In-House Child Protective Services (DFCS)

Medical:

Immunizations

Testings / Screenings / Health Fairs

Medical Treatment: General

Medical Treatment: Mental Health

Medical Treatment: Substance Abuse

Medical Treatment: Home Health

Medical Treatment: Physical Therapy

Medical Treatment: Dental

Medical Treatment: Optical (Eyeglasses)

Counseling / Support Group:

Case Management

Sexual Abuse / Domestic Violence

Veterans

HIV / AIDS

Sexual Orientation

Religious

Parole Rehabilitation

Addiction / 12-Step

Mental Health / Mental Retardation / Developmental Disabilities

Family / Parenting

Post Traumatic Stress Disorder

Education / Employment:

Employment Assessment

Training

Placement

Resume Assistance

Parenting Support

Health

Language / Literacy

GED Preparation

Financial / Tuition Assistance

Computer Training

Life Skills

Financial / Budgeting

Financial Help:

Rental Assistance

Utility Assistance

Temporary Assistance for Needy Families (TANF/DFCS)

Supplemental Security Income (SSI) / Supplemental Security Disability Income (SSDI)

Benevolence / General Funds

Mortgage Assistance

Relocation Assistance

Holiday Assistance

Medical

Hotel / Motel

Car Repair / Insurance Assistance

Legal Assistance:

General

Child Support / Custody

Temporary Protective Orders / Domestic Violence

Discrimination

Criminal Cases

Landlord / Tenant

Immigration

Public Benefits

Additional Notes:

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