REQUEST FOR HOMELESS FAMILY SERVICES

If you are seeking services or if you know of a homeless family or a family on the brink of homelessness, refer them here or call us at 470-560-0854
To request ESFSG services, complete the below application form and the intake form at this link. Send the form to referral@exousiahouseofgeorgia.org. Submitting your application without the intake form results in an automatic DISAPPROVAL.
Now, please complete the INTAKE FORM. Email the completed intake form to referral@exousiahouseofgeorgia.org
What Services do you Seek?
What Service are you Requesting?
ARE YOU A DOMESTIC VIOLENCE VICTIM?
Domestic violence victims receive referrals that require strict confidentiality.
HEAD OF FAMILY (NAME)
Enter the circumstances surrounding your/their homelessness
Name of Child 2
Include your county and state
Is this a military veteran family?
Are you employed??
EMPLOYMENT
Please enter your employment status
Unemployment Information
Please select all that apply
Monthly unemployment amount
This completed form is required to receive ESFSG Services.
COPY AND PASTE THIS LINK INTO YOUR BROWSER
Mail your intake form to this email address
FOR ESFSG SUPPORT AGENTS ONLY
One of our Support Agents will contact you within 48 hours. If this is a medical emergency, please dial 9-1-1.
#exousiahouse
216 Atlanta Rd Suite F , PMB 1027 Cumming GA 30040 US
Quick links
Donate
Join us in creating a more supportive culture.
Exousia House of Georgia is a 501(c)(3) nonprofit organization, EIN 88-4261879. Donations are tax-deductible. ©2022-2025. Copyright © All rights reserved.