General 3 — Highbanks Society

If you are a single mom (or will be soon) and would like to apply to live at Highbanks, please fill out the form and we will reach out to you as soon as possible,

Name *

First Name

Last Name

Email *

How did you hear about Highbanks? *

Today's Date *

YYYY

Phone *

(###)

###

####

Address (if possible) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

YYYY

Primary language *

Are pregnant or parenting? *

If you are parenting, what is the birth date & name of your child/ren? If you are pregnant, please list your due date.

Do you currently have custody of your child/ren? *

Is child welfare currently involved with your family/child(ren)? *

If not currently, has child welfare been involved with your family/child(ren) in the past?

Where have you been living for the past 30 days? *

Are you currently homeless? *

Yes

Are you currently at risk of becoming homeless? *

Yes

If you are currently homeless, how long have you been homeless for? *

How many times have you been homeless in the last 2 years?*

How many times have you been homeless in your life? *

Do you feel safe where you are currently living? *

Yes

Somewhat

Are you currently attending or enrolled in school? *

Yes

Are you currently recovering from substance abuse? If yes, how long?*

Why do you want to live at Highbanks? *

If you can, tell us a bit about why you think you're a good fit for our program.

Are you vaccinated against Covid-19?*

Yes, One Dose

Yes, Both Doses

Have you been diagnosed with any mental or physical medical conditions that may impact your ability to fully participate in the Highbanks program? Are you taking prescribed medications for this? If yes, please describe.*

Thank you for taking the time to apply to live at Highbanks. We will review your application and get in touch as soon as we can.

Supportive, Empowering, Positive, Knowledgeable, Generous, Welcoming, Hopeful, Trustworthy

Our vision is a community of educated, confident, self-sufficient parents raising healthy, happy children.

Our mission is to provide affordable housing and a nurturing community where young families can learn and grow.

Get Involved Contact Our Honey Story Community Partners

We acknowledge that we live, work, & play on the traditional territories of the Blackfoot Confederacy (Siksika, Kainai, Piikani), the Tsuut’ina, the Îyâxe Nakoda Nations, the Métis Nation (Region 3), & all people who make their homes in the Treaty 7 region of Southern Alberta.