YWCA of Western Massachusetts

Additional Links - Please review prior to filling out this application:
This form must be filled out all at once so please make sure to review the form first and have all necessary information on hand before beginning.  If you have any questions please contact the Property Manager at 413-732-3121 x470.


Program Description

The YWCA Supportive Housing Program is an 18–24-month supportive housing program that is designed to help survivors achieve independent living situations within the community. Monthly rent provides women with an apartment, laundry facilities, case management services and group meetings. Residents set self-sufficiency goals with a case manager and work toward the achievement of those goals by participating fully in the program.

Criteria for Acceptance and Participation:

  • Applicant must have a history of being a victim of domestic violence, dating violence, sexual assault or stalking.



  • Domestic Violence – includes actual or threatened acts of violence committed by a current or former spouse of the victim, by a person with whom the victim shares a child in common, by a person who is cohabiting with or has cohabited with the victim as a spouse or partner or by any other person against an adult or youth victim who is protected from that person‘s acts under the domestic or family violence laws of the jurisdiction. Domestic violence can be physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person. This includes any behaviors that intimidate, manipulate, humiliate, isolate, frighten, terrorize, coerce, threaten, blame, hurt, injure, or wound someone.
  • Dating Violence – violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors:
    • The length of the relationship
    • The type of relationship
    • The frequency of interaction between the persons involved in the relationship
  • Sexual Assault – defined as any type of sexual contact or behavior that occurs without the explicit consent of the recipient of the unwanted sexual activity. Falling under the definition of sexual assault is sexual activity such as forced sexual intercourse, sodomy, child molestation, incest, fondling, and attempted rape.
  • Stalking – means –
    • (A) (i) to follow, pursue, or repeatedly commit acts with the intent to kill, injure, harass, or intimidate another person; and (ii) to place under surveillance with the intent to kill, injure, harass or intimidate another person; and
    • (B) in the course of, or as a result of, such following, pursuit, surveillance or repeatedly committed acts, to place a person in reasonable fear of the death of, or serious bodily injury to, or to cause substantial emotional harm to –
      • (i) that person;
      • (ii) a member of the immediate family(spouse, parent, brother, sister, or child of that person)
      • (iii) any other person living in the household of that person and related to that person by blood or marriage of that person; or
      • (iv) the spouse or intimate partner of that person;
    • Perpetrator – means person who commits an act of domestic violence, dating violence sexual assault or stalking against a victim.


  • Applicant must be homeless or on the verge of homelessness: An individual is considered homeless if they are:
    • Sleeping in an emergency domestic violence shelter or living in other homeless shelter/program because of domestic violence, stalking, sexual assault or dating violence
    • Residing in other transitional housing program for domestic violence for past 12 months and unable to identify long-term permanent housing option
    • Aging out of a Teen Living Program and unable to identify long-term permanent housing option. Must have a history of domestic violence, dating violence, sexual assault or stalking.
    • Being discharged from a correctional facility and having no subsequent residence identified and lacking the resources and support networks needed to obtain access to housing.
    • Fleeing domestic violence, dating violence, sexual assault or stalking.
    • Has a primary nighttime residence that is a public or private place not meant for human habitation
    • We will also consider applications from those who have discharged from one of the above and a supportive housing program would assist them in becoming more self-sufficient
  • Applicant must be a resident of Hampden County

Application Process:

An interview will be scheduled when an apartment is becoming available. Verification of income is required.

  1. Applicant must complete an application and be interviewed by the YWCA’s Supportive Housing Program staff to determine eligibility and the YWCA’s ability to meet their needs (see attached for specific application instructions).
  2. Applicant must demonstrate ability to pay for electricity in the unit. The applicant must also pay an initial security deposit equal to 1st months rent. If the applicant requires assistance with payment, the YWCA will assist in connecting them with available community resources.
  3. Applicant must be willing to work on an individualized self-sufficiency plan and meet with a case manager weekly or bi-weekly
  4. Applicant must be 18 years or older.
  5. Applicant must demonstrate the ability to live with a diverse population of people and to respect different lifestyles and choices.
  6. Applicant understands that this is a supportive living environment and individuals not covered under the lease cannot reside within the unit.

Agreement to participate in services

I have applied for residency at the YWCA. If accepted into the program, I agree to abide by the conditions listed above, and I understand that the purpose of the program is to help me achieve greater independence. *

Application for Housing

Project: YWCA Supportive Housing Program

Address: 62 Marcia Haas Circle, Springfield, MA 01118

Telephone: (413) 732-3121

Referral Information

General Information

Check all that apply to the phone number: *
Race *
Ethnicity *
Primary Language *
Secondary Language(s)
Disability *
Bedroom size requested *

Household Composition

Do you have a birth certificate and social security card, or a green card? *
Do you anticipate any other changes in household
composition in the next twelve months? *


Monthly Income Sources [Select all that apply]: *
Non-Cash Benefits [Select all that apply]: *

Additional Information

Have you or any member of your family ever been
convicted of a felony? *

Pet Information (if applicable)

Do you have any pets or any type of
service and/or support animal? *
Will any or all of these animals also need housing? *


I/We hereby certify that I/We Do/Will Not maintain a separate subsidized rental unit in another location. I/We understand I/We must pay a security deposit for this apartment prior to occupancy. I/We understand that my eligibility for housing will be based on applicable income limits and by management’s selection criteria.

I/We certify that all information in this application is true to the best of my/our knowledge and I/We understand that false statements or information are punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy. All adult applicants, 18 or older, must sign application.

Head of Household Signature *

Applicant Background

C. Current Living Situation *
D. Do you currently have the ability to pay the deposit and turn on and maintain your electricity? *
E. Criminal Justice History:
I certify the information in this application is true and correct. I authorize the YWCA Supportive Housing Program to contact the sources listed in this application for the purposes of verifying the accuracy of the information. In addition, I understand that Wayfinders will be running a background check on me. *