Homeless? Hungry? Living from couch to couch? Need help? Take the first step toward finding a safe space. We offer resources to connect you with safe secure housing. Let us help you. Sometimes all you need to break the cycle of substance abuse is a clean bed, a nutritious meal and the support of someone who believes that you have value. You are not alone. The road to recovery starts here. Substance abuse and dependences are often driven by an underlying cause. Our approach to recovery for you begins with you realizing you need help. Are you tired of the seamlessly endless cycle of homelessness & substance abuse.

Are you willing to take a step forward to sober living? Then you are not alone, we are here for you. Let us help you get the process started. Please fill out the following form if you need assistance:

Please complete as much of this form as possible for a quicker response. The answers you provide will assist us with the best solution to your current situation.

Date

YYYY

Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Are You Homeless?

Living in a shelter

Living in a motel/hotel room

Living in your car

Living with friends

Living on the street

None of the above

Is There Substance Abuse?

Yes

If Yes, what type of Substance?

If Yes, when was the first use, last use, and how often?

How were you referred to Crossroads?

Call In

Walk In

Shelter

Family Member, Friend, or DCS Worker

Do you have in your possession any of the following IDs?

Social Security Card

Birth Certificate

State ID or Drivers License

Medical Insurance

What are your immediate needs?

Housing/Shelter

Drug Detox

Alcohol Detox

Detox, Rehab, & Aftercare

Medical Issues

If you chose Shelter, do you have someplace safe to stay tonight?

Yes

If you do not have a safe place to stay tonight, please call us directly for a list of community shelters at (520) 345-3221

Thank you! We will get back to you soon as we can.

Crossroads Youth and Community Group P.O. Box 90203 3206 W. Jusnic Circle Tucson, AZ 85752-0201

(520) 333-3357

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Crossroads Youth and Community Group is a 501(c)(3) non-profit organization based in Tucson, AZ, that focuses on providing services and resources to youth transitioning out of foster care and into adulthood.