Application Form

Thank you for your interest in Gemini Havens. Please complete this application form to help us understand your housing needs and support a smooth placement process.

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Reserve Your Bed at Gemini Havens

Free Pre-Consult Available • Fast Response • Simple Intake

Application Form

Personal Information

First Name

Last Name

Date of Birth

Phone Number

Emergency Contact Phone Number

I am applying as:

Housing Information

Preferred Move-In Date

Preferred Stay Duration

Are you currently employed?

Do you currently have transportation?

Do you require access to transportation resources?

Preferred Accommodation Type

Do you have any accessibility or mobility needs?

Please tell us anything that would help us support your housing experience:

Community Guidelines Agreement

To help maintain a supportive living environment, applicants acknowledge that they understand the expectations of community living.

I understand and agree to follow Gemini Havens Community Guidelines.

I understand placement is subject to availability and review.

I certify that the information provided is accurate.

Preferred Contact Method

Phone

Text Message

404-692-7070

Application Form

Reserve Your Bed at Gemini Havens

Personal Information

Housing Information

Community Guidelines Agreement

Compassionate Care – Proven Support

Company

Dekalb County, GA