Housing Application

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To submit an application for housing at MHAB Life Skills Campus, please take the time to fill out the information below.

First Name

Last Name

Email

Phone

Emergency Contact Name

Gender Identity

Birthday

Emergency Contact Phone

Social Security Number

Are you a veteran?

Yes

No

Are you homeless?

Yes

No

Disability?

Yes

No

Current Address

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Thanks for submitting!

518-324-6422

14 Dormitory Drive, Plattsburgh NY 12903

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