Bridge Guidelines and Consent

Voluntary Action Center
Bridge Program Agreement and Application


COMPLETE APPLICATION DOCUMENTS:  Individuals seeking shelter in the Bridge Program must complete the following documents to be eligible for admission into the program.


  1. Intake Application
  2. Bridge Program Agreement (this document)
  3. Background Check

 PROVIDE REQUIRED DOCUMENTATION:  Individuals seeking shelter must provide required documentation at the time of intake or within seven (7) days of intake. 

  1. Proof of income for all adults in the household. You need to provide proof of all income received by individuals living in the household.  Sources of income include paystubs, government benefits, child support, food stamps, or settlement payments.  If you do not have income you will be required to show proof of a minimum of ten (10) job applications per week. 
  1. Proof of homeless status. You will be required to provide proof of homeless status through an eviction notice, referral letter, or authorized request to vacate premises.  The Case Manager will provide more information about required documentation.
  1. Identification Documents. Documents must be provided for all individuals.  These documents will be required for you to obtain housing and employment.  If you do not have access to these documents notify the Case Manager and they will assist you in obtaining these documents.
  1. Georgia Photo ID or Georgia Driver’s License or Military ID or Passport for all adults
  2. Birth Certificates for all individuals in the household
  3. Social Security Cards for all individuals in the household

SUBMIT TO A DRUG TEST:  All adults wishing to be housed in the Bridge Program must submit to a drug test at the time of intake.  You will be asked to tell the Case Manager if you have used any illegal substances. 

If you disclose use of illegal substances, you will be given seven (7) days stay in the program and given an opportunity to re-test.  If you pass the second drug test you can remain in the program.  If you fail the second test you will be terminated from the program.  If you do not disclose use of illegal substances and fail the drug test you will be given a maximum of seven (7) days in the program.  If you refuse to submit to a drug test you will not be placed in the program. 

Result of a failed drug test will not be shared with law enforcement, parole, or probation officers.  Results of failed drug tests will only be shared with the Department of Family and Children Services by the VAC or on behalf of the VAC by a referring school entity.

ATTEND WEEKLY MEETINGS AND ADHERE TO WEEKLY ACTION PLANS:  You will be given a weekly action plan.  This plan will give you tasks to complete each week.  If you do not complete required tasks before your weekly appointment date your stay in the program may not be extended.    Weekly plans may include requirements to look for employment, apply for housing, save money, or other tasks which are required to ensure you have stable housing.

 MAINTAIN EMPLOYMENT:  This is a work-based program which requires you to obtain and maintain adequate employment.  Monthly income is required to ensure you and your family are able to obtain and maintain stable housing.

SEEK HOUSING:   You will be required to complete and submit applications for housing.  The VAC Case Manager can assist you if necessary. 


You are not allowed to bring PETS into the hotel room.  You are not allowed to have guests staying with you in the room.  You are not allowed to bring any cooking items into the hotel room.  A microwave is provided for your use.  You cannot remove any items from the hotel room which belong to the hotel.  You cannot bring large items or furniture into your room.  Your room will only be cleaned weekly.  You are responsible for maintaining the cleanliness of your room. 


Legal parent(s) or guardian(s) of minors who were living in the household at the time of becoming homeless will be allowed in the program.  Legal partners or spouses of legal parents and guardians living in the household at the time of becoming homeless will be allowed in the program.  Adults who are listed on the eviction notice or referral documents will be allowed in the program.  Any other adults will not be allowed in the program.  If unauthorized adults (such as boyfriends, girlfriends, relatives, or friends) are found to be staying in the room you will be immediately terminated from the program. 



The maximum length of stay in the Bridge Program is thirty (30) days.  The maximum length of stay can only be extended under extenuating circumstances and requires the approval of the Executive Director.  The Case Manager is not authorized to extend your stay beyond the maximum length of stay. 

You are not automatically approved for a thirty (30) day stay.  Your stay length will be determined by the Case Manager and your completion of weekly tasks.  Your stay will be approved on a weekly basis and extended at the discretion of the Case Manager.   If you do not meet all program criteria you may not be approved for the maximum length of stay.  You will be notified by the Case Manager upon intake if you are not qualified for the maximum length of stay.


A Participant will be immediately terminated from this program for any of the following behaviors:



Individuals seeking shelter in the Bridge Program must comply with the terms and conditions of this Program Agreement.  It is the responsibility of the individual seeking shelter to review this agreement at the time of intake.  Acceptance into the Bridge Program requires your agreement to accept the terms of this agreement by signing this document below.  If you fail to provide consent by signing this document, you will not be accepted into the Bridge Program. 

By signing below you agree that you have read the Bridge Program Guidelines and Agree to the terms outlined above. Applicant Signature *

Release of Information

Complete this first section about you, the person completing this application.

Complete this section for all individuals living in your home with you.
Individual #1
Individual #2
Individual #3
Individual #4
Individual #5
Individual #6

The Gordon County Community Services Network, hereinafter referred to as “GCCS Network”, is a shared, internet based record keeping system that records and stores information about emergency services provided, including but not limited to utility assistance, food, medication, rent/mortgage assistance, etc.  The Voluntary Action Center serves as the administration of the GCCS Network on behalf of Member Organizations.

I understand that all information gathered about me is private and that participation is voluntary.  I have had an opportunity to review this form and understand that the information collected regarding my assistance records is accessible by GCCS Network Members. 

This Release of information will remain in effect for three (3) years from the date noted by my signature at the bottom of this page unless I make a written request to this Organization to be removed from the GCCS Network.

I authorize the Voluntary Action Center, as a GCCS Network Member, to share my identifying information as well as assistance information, including denial of service within the GCCS Network.  I also authorize GCCS Network Members to make referrals to appropriate service providers, in an effort to implement service plans.  I understand that such service may include health, educational, psychological, nutritional, housing, financial, employment, and other services which may apply.  I understand that this information will be kept confidential by GCCS Network Members, unless required by law, as in situations such as child abuse or threats of harm to self and others.  In no instance, other in such required reports, will this information be provided to individuals or agencies that are not a part of this process.

I hereby authorize Voluntary Action Center to request information regarding education, income, medical, household composition, family services received, and psychological information as required to determine eligibility as well as services provided.  I understand that I must submit all information and forms requested by the Voluntary Action Center before my application will be considered for aid. 

I understand that by submitting an application for aid, I, and other members of my household, may have various assessments completed by the Voluntary Action Center staff, and agree to be an active participant in the implementation of the resulting service plans.  My signature below indicates my agreement for all individuals living in my home as listed on the back of this document, to participate in the process, as well.  It is my understanding that I may withdraw from participation at any time.

Relase of Information Terms Agreement *
Client's Authorizing Signature *

Bridge Application

The following questions must be answered to complete the application.  Information must be provided for all individuals currently residing in the household.  Anyone not listed on this application will not be allowed into the program.
Do all parents currently live in the household? *

Work Eligibility

Are any adults in the home disabled and unable to work? *
Does anyone in the household draw disability or has applied for disability? *

Client Questionnaire

Were you evicted from a residence in Gordon County? *
Is your name on the eviction notice? *
Do you have a referral from a partner agency? (Calhoun City Schools, Gordon County Schools, Department of Family and Children Services, or Domestic Violence) *

Do you fear for your safety or the safety of your children? *
Have you ever lived at the Calhoun Housing Authority? *
Have you ever been evicted from the Calhoun Housing Authority? *
Have you completed an application for the Calhoun Housing Authority? *
Do you have any family members who live nearby who can provide assistance or a place to stay? *

Client Documentation

Do you have birth certificates for all household members? *

Do you have social security cards for all household members? *

Do all adults have a driver's license or picture ID? *

Budget Worksheet

List all sources of income you currently receive.  If someone gives you cash that is considered income.
Do you receive food stamps? *
Total Monthly Income:
List all monthly expenses you are currently paying.
Total Monthly Expenses:
By Signing Below you agree that all information provided is accurate. *