We are a non-profit housing organization for transitional independent living, servicing south Sacramento and the surrounding areas. Globally Love and Care exists to build up our community by focusing on providing the fundamental necessities to those that have been underserved. Many fall upon hard times in their lives, and it is our mission to get them back on their feet. We provide a path beginning with physiological and safety needs, and lead them to develop belonging, esteem, and self-actualization in life. We accept people from all walks and welcome them into our growing community.
Globally Love and Care
Housing Request Form
Are you requesting housing for yourself or someone else?
Myself
Someone else
💬 Your Information
Who is making the request?
What agency do you work for?
What is your relationship to them?
Office Address:
Your Name:
Phone Number:
E-Mail:
Fax Number:
📝 Their information
First Name:
Middle Name:
Last Name:
Date of Birth:
Gender: Why do we ask this? info
Male Female
Transgender
Preferred Pronouns:
Current Address:
Phone Number:
E-Mail:
Are they Fully Ambulatory? Yes No
Please Describe:
Do they require Handicap Access? Yes No
Please Describe:
Do they have any Mental Health Concerns? Yes No
📝 Your information
First Name:
Middle Name:
Last Name:
Date of Birth:
Gender: Why do we ask this? info
Male Female
Transgender
Preferred Pronouns:
Current Address:
We need some way to contact you.
Phone Number:
E-Mail:
Are you Fully Ambulatory? Yes No
Please Describe:
Do you require Handicap Access? Yes No
Please Describe:
Do you have any Mental Health Concerns? Yes No
🧑 Payee Information
Do they have a Payee? Yes No
Are you their payee? Yes No
Is the Payee part of an agency? Yes No
Agency Name:
Office Location:
What is their relationship?
Payee Name:
Payee Phone Number:
Payee E-Mail:
Payee Fax Number:
🧑 Payee Information
Do you have a Payee? Yes No
Is the Payee part of an agency? Yes No
Agency Name:
Office Location:
What is their relationship?
Payee Name:
Payee Phone Number:
Payee E-Mail:
Payee Fax Number:
👮 Criminal Background Information
Are they on Probation? Yes No
Are they on Parole? Yes No
Are they a Sex Offender? Yes No
Case Number(s):
Officer Name:
Office Location:
Officer Phone Number:
Officer E-Mail:
Officer Fax Number:
Is there anything else we should know about?
👮 Criminal Background Information
Are you on Probation? Yes No
Are you on Parole? Yes No
Are you a Sex Offender? Yes No
Case Number(s):
Officer Name:
Office Location:
Officer Phone Number:
Officer E-Mail:
Officer Fax Number:
Is there anything else we should know about you?
💭 Questions? Do you have any questions for us?
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Globally Love and Care

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Your Organization (if any):
Your Phone Number:
Your E-Mail:
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