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Menu
Home
About
AMHH Board
Documents and Forms
Programs/Services
Resources
Support Group Registration
Donate
Special Events
SWFL Santa's
Get Involved
Thanksgiving Potluck
Christmas Potluck
Parents Area
Mother & Child Events
Please fill out the form below. Once it is received, a zoom appointment will be scheduled based on your availability and our open appointments.
Intake Questions
*
Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
Meetings are scheduled in the evenings Monday - Friday at 6:30 pm or Saturday afternoons. Do you have a preference of day?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Do you have any expectations of the program? If so waht are they?
*
I hope to achieve the following goals within the next year
*
What do you think would help you achieve these goals?
*
I understand that in order to receive assistance from any of the programs offered by AMHH, I must meet the following requirements
Be living a single lifestyle with no significant other in the home
Live in Lee County
Have children under 18 at home or 21 if in college
Must attend at least 2 support group meetings per quarter
By typing your name below, you agree to the above requirements
*
Submit
Home
About
AMHH Board
Documents and Forms
Programs/Services
Resources
Support Group Registration
Donate
Special Events
SWFL Santa's
Get Involved
Thanksgiving Potluck
Christmas Potluck
Parents Area
Mother & Child Events