House of Peace application form

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Name & Surname *

First

Last

Email *

Gender *

Date of birth *

Age *

Skills *

ID Number *

Whatsapp number *

Medical conditions *

Substance abuse history *

Reason for situation? *

Current living situation *

House of Peace operates on a contribution system to ensure sustainability. The standard contribution is R1,700 per person per month. If you are unable to afford the full amount, an adjusted contribution may be considered based on your circumstances. Can you afford to make the monthly contribution? *

other an make

How much can you afford monthly? *

What other shelters have you stayed at? *

ID Document (Back & Front) *

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Current photo of yourself *

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Supporting Documents

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If you have any documents that can support your application, such as medical or referral letters, please upload them here.