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img 604 East 38th Street, Indianapolis, IN 46205
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Transitional Housing Application

If you or someone you know needs our services, print out the resident application below. Once you have completed it, you can mail, fax, or drop it off in person to us. No application is necessary to access our other services, only our in-come based transitional housing services.

If you have any questions about our programs or services, please contact us at 317-923-5750 or by email.
Download the RESIDENT APPLICATION in .pdf format.

*You will need Adobe Reader to view and print the application. If you do not have Adobe Reader, you may download it for free.

Please mail, drop-off or fax your completed Transitional Housing application to:

Coburn Place Safe Haven
604 E. 38th Street
Indianapolis, IN 46205
317-923-5750 – phone
317-921-1946 – fax