IHH Placement Pre-Screen
⭐ Placement Screening Request — Isabel Hope Harbor
This form is a placement screening request, not a full application.
Isabel Hope Harbor provides structured transitional living for adult men (21+) in Dallas.
Qualified individuals will be contacted to complete a verbal screening before receiving a full application.
⭐ SECTION 1 — Contact Information
Full Name
Client first nameClient last name
Phone Number ⭐
Client phone
Email Address
Client email
Preferred Contact Method
⭐ SECTION 2 — Basic Eligibility
Are you male and 21 years or older?
Are you willing to live in a drug- and alcohol-free home?
Do you have a funding source available for housing?
Are you required to register as a sex offender?
⭐ SECTION 3 — Current Situation
Where are you currently staying?
Expected Move-In Date
Date
⭐ SECTION 4 — Program Readiness
Field Type: Yes / No
Are you willing to follow house rules, share a room, and live in a structured environment?
Field Type: Yes / No
Are you currently clinically stable and not in need of detox, treatment, or medical supervision?
⭐ SECTION 5 — Program Understanding
Field Type: Required Checkboxes
Applicant must check:
Checkboxes
⭐ SECTION 6 — Optional Notes
Field Type: Paragraph Text
Anything else you would like us to know?
Paragraph
⭐ SUBMISSION CONFIRMATION MESSAGE
Thank you for submitting your placement screening request.
A team member will review your responses and contact you within 24–48 hours if eligibility requirements are met.