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Request Shelter at Connections

For youth up to age 18 who need safe and temporary shelter when they are unable to stay at home.

YOUTH INFORMATION

First Name

Last Name

Youth's Date of Birth

Youth's Age

County

Phone

Email

Gender

Race/Ethnicity

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Current Living Situation

REFERRAL INFORMATION

Who is completing this form? *

Youth in Need of Shelter

Adult on Behalf of Youth

Referring Adult's First Name

Referring Adult's Last Name

Referring Adult's Phone Number

Referring Organization (if applicable)

Thank you. A staff member will be in touch. If you need immediate assistance, please call 830-629-6571.

Request Shelter at Connections

For youth up to age 18 who need safe and temporary housing when they are unable to stay at home.

YOUTH INFORMATION

First Name(Required)

Last Name(Required)

Youth Age(Required)

Youth Date of Birth(Required)

Month

Day

Year

Phone(Required)

Email

County(Required)

Gender

Race/Ethnicity

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Current Living Situation(Required)

REFERRAL INFORMATION

Who Is Completing This Form?(Required)

Youth in Need of Shelter

Adult on Behalf of Youth

Our Supporters & Affiliates

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Texas Network of Youth Services

United Way of Comal County

Platinum Transparency

Texas Network of Youth Services

United Way of Comal County

HELP A YOUTH IN NEED. DONATE TODAY.

1414 W. San Antonio St.

New Braunfels, Texas 78130

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