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Online Intake Application

The Online Intake Form allows the staff at Kearah's Place to screen and qualify you  for our services.  This is a secure site. Any information transmitted over this site is secure and confidential.  PLEASE NOTE that if you are using a public computer or any computer that does not belong to you, remember to completely close out of the internet browser when you are finished. If you don't, you might accidentally share your personal information with someone else.   

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Disclaimer: This project was supported by Grant No. 2020-WH-AX-0007 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.


     

    Kearah's Place Inc.

    (Main Administrative Office)
    904 Dorsey Ave
    Henderson, NC 27536
    Phone: 252-598-2025

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