Shelter Request Form

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Request Shelter at Connections

For youth up to age 22 who need safe and temporary shelter when they are unable to stay at home.

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Youth Information

First Name(required)

Last Name(required)

Phone(required)

Email

Youth’s Date of Birth (YYYY-MM-DD)(required)

Age(required)

Gender

Race/Ethnicity(required)

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Middle Eastern or North African Native Hawaiian or Pacific Islander White

County(required)

Current Living Situation(required)

Referral Information

Who is completing this form?(required)

Youth in Need of Shelter Adult on Behalf of Youth

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Strengthening communities, one youth and one family at a time.

Call Us 24/7

830-629-6571

Address

1414 W. San Antonio St.
New Braunfels, TX 78130

Main Lobby Hours

Monday-Friday
8am-5pm

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