Emergency & temporary housing

Tell us what would make tonight safer.

This private application helps the Bunker team understand timing, safety, fit, and the next responsible step. You do not need perfect words.

Private by design

Sensitive answers are encrypted and kept out of email.

Reviewed personally

A Bunker administrator will follow up using your safe contact choice.

Not a guarantee

Capacity, safety, house fit, and guardian approval are reviewed first.

This is not a continuously monitored emergency service.

If someone may be in immediate danger, use local emergency services now. Do not wait for a response to this form.

Step 1

About the applicant

Start with who you are and how we can contact you safely.

Who is completing this form?

Applicant age

For anyone under 13, a parent or legal guardian should contact the Bunker directly.

Are you male or female?

Host homes are matched by gender, so we need this to find the right fit.

Name you go by

What should we call you?

Your legal name

Your date of birth

Social Security number — optional

Why we ask. We have had nights where someone in our care overdosed or had a serious medical emergency, and the hospital, the doctors, or the intake staff needed identifying information from us before they could treat or admit them. When we did not have it, it cost time nobody had. That is the only reason this field exists.

Leaving it blank is completely fine and never changes whether we help you. Fill it in only if Bunker staff asked you to.

Encrypted before it is stored. It never sits in our records as readable digits. Anyone who got hold of the database or a backup copy of it would find nothing but scrambled text.
Never emailed. Our own alert email says only that an application arrived. It carries none of your details.
Hidden even from us. Yosef and Sarah see only the last four digits. Unlocking the full number is a deliberate act — it takes re-entering a password, it is rate-limited, it hides itself again within a minute, and every single unlock is recorded.
Erased on a timer. It is deleted as soon as your application is reviewed, and after 30 days no matter what. The rest of your application stays; the number does not.

SSN — nine digits

No spaces or dashes.

Confirm SSN

Re-enter the same nine digits.

Your phone

Phone or email is required.

Your email

Phone or email is required.

Safest way to contact you

May we leave you a message?

Step 2

What is happening now

We need enough context to understand urgency, timing, and whether a family-home stay could be appropriate.

Current city or area

A general location is enough. Do not enter an exact street address.

Do you have a safe place to sleep tonight?

When would you need a stay to start?

Do you have a sense of where this is heading?

A next step, a place to land, a date — even a rough one. It is completely okay if the answer is no.

Please describe your housing situation

What changed, what is needed, and what would make the next few days safer?

Any immediate safety concerns for you?

Share only what the team needs to know to assess a safe stay. If you prefer, write “Please discuss by phone.”

Are your parents in the picture?

Is there any family you could fall back on, even short-term?

Your relationship with family right now

Parents, siblings, relatives — who is around, how things stand, and whether anyone could be part of the plan.

Is anyone supporting you or helping financially?

These next few help us picture what you can build on. There are no wrong answers, and nothing here decides whether we help you.

Do you have any way of making money right now?

Are you able to work right now?

Health, school, legal or transport reasons all count as limits.

Have you ever held a job? What was it?

Anything counts — camp, a store, a warehouse, landscaping, helping in a family business. If never, just say so.

Any skills, trades, or things you are good at?

Cooking, driving, tools, tech, music, working with kids, learning — whatever you have. This is often where a next step starts.

Step 3

School, insurance & care

Only share information that could affect a safe stay or help the team coordinate a responsible next step.

Do not enter a Social Security number. Insurance and medical information is encrypted and is not included in notification email.

Do you have health insurance?

No insurance is never a barrier to getting help — this only helps the team coordinate care if it is ever needed.

Last school you attended

Current school status

For example: attending, on leave, transferred, or not enrolled.

Do you have any medical needs, allergies, or medications relevant to a safe stay?

Have you had any inpatient hospital, behavioral-health, detox, or residential stay in the past 12 months?

Your clinician, caseworker, or care contact

Optional

Their phone or email

The Bunker may contact the clinician or care-contact listed above. Leave this unchecked if no contact was listed or permission was not given.

Step 4

Safety & background

Every applicant stays in a family's home, so we ask everyone these questions. Honest answers never disqualify someone from help — they let the team find the placement that is right and safe for everyone.

These answers are encrypted, are not included in notification email, and are seen only by the Bunker team.

Have you ever committed a serious offense against another person — for example rape, molestation, or another sexual or violent offense?

This includes anything that was never reported or charged. Because placements are in private homes, we must know before matching.

Do you have any other criminal record — arrests, charges, convictions, or juvenile cases of any kind?

Even minor or long-ago cases — a shoplifting charge at 15 will not keep anyone out of a warm home, but the team needs the full picture.

Step 5

Two people who know you

Choose adults who can speak honestly about you and your current situation.

Reference 1

Full name

Relationship to you

Phone

Phone or email is required.

Reference 2

Full name

Relationship to you

Phone

Phone or email is required.

Step 6

Review & send privately

Please confirm these points before the report is submitted to the Bunker admin.

To the best of my knowledge, the information in this application is accurate.

I have permission to share the references' contact information, and the Bunker may contact them about this application.

I understand that submitting this form does not reserve or guarantee a bed. Any stay depends on capacity, safety, house fit, and required guardian approval.

I authorize the Bunker team to use this information to assess temporary housing, contact the people named here, and coordinate an appropriate next step.

I would rather start with a conversation

Not ready to send it yet?

We will email you a short code that brings all of this back. The email says nothing about housing, and the Social Security number is never saved — you would enter that at the end.

Already have a code? Pick up where you left off.