Housing placement

Transitional Housing
Placement Questionnaire

This questionnaire helps Angels of Hope determine whether our structured transitional housing environment is an appropriate placement and what support may be needed.

Completion does not guarantee admission.

Before you begin

Angels of Hope cannot accept individuals required to register under California Penal Code 290 or individuals with convictions under Penal Code 288. Please share only information relevant to safe placement and continuity of care.

01 Who is completing this form?

Choose one. The questionnaire will show the questions relevant to you.

02 Applicant information
03 Current housing situation

What best describes the applicant’s current situation?

04 Justice involvement

Is the applicant currently under supervision?

Any additional pending charges or unresolved legal matters?

Does the applicant have court-ordered or statutory registration requirements?

Stay-away, keep-away, protective, restraining, or geographic restrictions

Has the applicant been released from jail or prison within the past three years?

Does the applicant have a CDCR number?

05 Gang history & safety considerations

Known gang affiliation or history

Known enemies, conflicts, safety concerns, neighborhoods, individuals, or residents the applicant should not be housed with?

06 Substance use & recovery

Has the applicant used alcohol or non-prescribed substances recently?

Current recovery participation

07 Mental & behavioral health support

Include only information needed for safe placement, service coordination, and continuity of care.

Does the applicant currently receive behavioral or mental-health services?

Any treatment, supervision, follow-up, or reintegration requirements AOH should coordinate?

Is the applicant transitioning from:

Must appointments, treatment plans, follow-up services, or community providers be maintained after placement?

08 Medication support information

List medications only when necessary for safe continuity of care and placement coordination.

Is the applicant taking prescribed medication that may require coordination, storage, follow-up, or continuity of care?

Does the applicant require help coordinating prescriptions or medical appointments?

09 Prior program history

Has the applicant participated in structured housing, treatment, shelter, or another structured program during the past 12 months?

Significant issues during a recent placement

10 Current functioning & reentry needs

Which areas currently require the most support?

11 Applicant readiness

Angels of Hope is a structured program. Residents participate in recovery and reentry planning, follow house expectations, communicate with staff, maintain accountability, comply with supervision requirements, and work toward long-term stability.

Three most important goals for the next 6–12 months

Program commitment

This program is not for everybody.

Our housing is more than a place to sleep. It is a structured environment focused on recovery, accountability, responsibility, employment, education, legal compliance, life skills, and successful community reintegration.

Follow program and house expectationsRespect staff, peers, neighbors, and propertyRemain accountable for actionsParticipate in recovery and reentry planningMaintain communication with staffWork toward productive activityComply with legal and treatment requirementsAddress problems and accept feedbackWork toward permanent housingMake a genuine effort toward positive change
13 Consent & confirmation
What happens next?

Your completed questionnaire will be sent directly to Angels of Hope. Keep the confirmation number shown after submission for your records.

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