JHM Client Application - Downtown Jimmie Hale Mission, Inc.

Take the first step to lasting transformation today by filling out the application below. Once our staff reviews the information provided, we will contact you regarding your next steps.

PLEASE NOTE:  All incoming clients are required to take a COVID-19 test before entering the program. We are more than willing to assist you in the process if needed. Please call us at 205-324-2271 if you have any questions about testing.

 

JHM Client Application

Step 1 of 6

  • Applicant Information:

  • Date Format: MM slash DD slash YYYY
  • *This email will be used for general contact needs and is where you will receive a copy of your completed application as well as any necessary follow-up information.
  • Emergency Contact Information:

  • Additional Information:

Copy link
Powered by Social Snap