THI Mentoring Application Form

Please print, complete, and send by fax or mail to:

Transitional Housing, Inc.
Attn: Denise Jackson
1545 West 25^th Street
Cleveland, Ohio  44113-3103

Fax: 216 781-2252

Name:     ______________________________________________________________

Address:  ______________________________________________________________

Address:  ______________________________________________________________

City:        ________________________________   State  ________   Zip  _________

Phone - Day:          (____) ___________________

Phone - Evening:    (____) ___________________

E-mail address:       _____________________________________________________

Gifts that I can share as a mentor:  _________________________________________

______________________________________________________________________

______________________________________________________________________

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Thank you for your interest in Transitional Housing, Inc.
We'll be in touch with you!