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Application and Referral Form

Mountain Home provides residential and mental health services to young women and children. Mountain Home’s residential services are offered to women who are between the ages of 16 and 24. Mental health services are offered to women between the ages of 16 and 29 and any children under the age of 18.

 

To begin the process for yourself as an applicant or if you are a medical professional referring another, please begin the process using the form below.


*Disclaimer: It is asked of each individual to complete this application as honestly as possible. The answers provided alone do not affect whether the referred applicant will be able to participate in Mountain Home Montana programs. Eligibility will be determined during an intake interview which will be scheduled after this application is submitted. For more information, or to make a referral over the phone, please call our intake coordinator at (406)-830-7612. 

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Mountain Home Montana is a 501c3 organization providing shelter for young mothers who need a place to live, and a network of support as they create safe, stable, and nurturing homes of their own.

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