Please fill each question to the best of your ability and our Case Manager will respond as soon as possible.  This information will be used only by staff of Family Promise of San Gabriel Valley to determine eligibility and will be held confidentially outside of this purpose. Please note, the minimum eligibility requirements for our program include:

  • There must be at least one minor child (under 18) in the household at entry.
  • All participants must be able to climb stairs and be willing and able to sleep on an air mattress.
  • All participants must be willing to submit to a drug screening and undergo a criminal background check. We are not able to accommodate those that are actively using drugs and/or alcohol, or been convicted of a felony or sex crime.
  • We are unable to serve those actively fleeing domestic violence and need a confidential, safe house setting
  • Adult members of the household must be able and willing to increase their income in order to sustain housing. Please note we are not able to offer subsidized housing but will work with families to determine if they may qualify for any housing programs.
FPSGV Program Services Interested In:
First Name *
Last Name *
Names and birthdates of ALL adults in your household for whom you are seeking services:
Names and birthdates of ALL Children in your household for whom you are seeking services:
Best Contact number to reach you:
Do you have a valid government issued ID?
Who referred you to Family Promise of San Gabriel Valley?
Is anyone in your household pregnant or potentially pregnant?
School(s) that child(ren) are enrolled/attending, if applicable?
Do you need assistance finding childcare?
Mental Health Services
Are you or anyone in your household currently receiving mental health services, such as talking with a counselor, taking medications to help manage a mood related issue or working with a psychiatrist?
Health Condition
Do you or anyone in your household have any chronic health conditions that would impact your ability to work, climb stairs, and/or actively participate in case management?
What City did you sleep in last night?
What was your last permanent address?
Address Line 1 *
City *
State/Province *
Postal Code *
Housing Situation
Current Housing Situation: (Check one or more)
If you specified "Other" to the current housing situation, please explain:
For how long have you been experiencing homelessness? (Please specify in years, months, weeks, and/or days)
What led to your current homeless situation?
How did COVID impact your homelessness?
Are you or any other adults in the household not currently working or looking for a job at this time?
If YES, please identify place of employment, hours worked per week, and monthly income for each adult.
If NO, how long since last job?
Job Search
Are you/other adults not currently working looking for a job at this time?
If YES, what kind of work are you looking for? If NO, please explain.
Please check any of the benefits listed below that you and/or other household members are receiving:
Total Household Income (not including CaFresh):
Please share with us what services you feel that you need to meet your immediate needs and short term goals.
Other Agencies
Are you working with any other agencies or case managers now, or in the last 6 months?
If YES, please share the name of the agency and case manager
Other Services
Have you received motel vouchers or other services from DPSS/CalWorks, a Family Solutions Center or any other agency?
If YES, please specify when and from whom.

Besides connecting to Family Promise of SVG, if you have not been connected to a Family Solutions Center in your geographical area, please call 211 to be connected

For more information on the Family Solution Center System, click here

For more information on Los Angeles County DPSS homeless assistance programs, click here