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Current Minimum
Requirements

18 or older
Currently expecting or less than 30 days postpartum

If you are interested in becoming a resident, please fill out the application below.

Selah's is a pro-life, transitional residential program for pregnant women and not a crisis shelter.

If you don't fit our criteria and need safe shelter, please click here for other resources,

go to your local emergency room or call 911.

Application for Residency

(The answers to this form are kept confidential and will be used for the sole purpose of initial contact.)

First Name

Last Name

Email

Phone

Have you seen a doctor to confirm your pregnancy? *

Yes

No

Do you have any other children in your custody? *

Yes

No

Are you currently on probation? *

Yes

No

If yes, how far along are you? *

1-12 Weeks (1st trimester)

13-26 Weeks (2nd trimester)

27- 40 Weeks (3rd trimester)

Unsure and need an ultrasound

If yes, what are their ages?

If yes, what for?

Are you willing to commit to a program? *

Yes

No

I need more information

Have you in the past or are you planning to apply for disability? *

Yes

No

If yes, what for?

Is it safe to call or text you?

14930 Laplaisance, Suite 106

Monroe, MI 48161

Phone: 734.244.5123

©2024 Selah's Center of Hope

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