/ How to Apply

Alpha House asks women/families to engage in our program for a minimum of six months, giving them time to engage with our counselling team and recover from the impacts of abuse. When women are ready to exit the program, we work with them to find housing in the community. Women and their children are welcome to attend follow-up counselling once they have completed the program.

Alpha House also offers non-residential counselling; an option for women who are looking to heal from the effects of intimate partner violence but who are safe to remain where they are living. Childcare can be provided, and the services are free of charge.

What’s Required of You?

  • Be committed to making a positive lasting change in your life
  • Be willing to participate in programs, including meeting twice a week with the women’s counsellor for personal counselling, once a week with the children’s counsellor, and attending two support group sessions per week.
  • Agree to care for and respect your suite.

We know it’s not going to be easy, but if you’re committed to making this positive change in your life and the lives of your children then we’re committed to doing everything in our power to make sure that you’re equipped to succeed.

How to Apply

To apply, fill out the form below.  If you prefer to email or use physical mail, download the Applicant Form, complete it and email to womenscounsellor@alphahouseproject.ca or mail your completed application to us at:

P.O. Box 37015
RPO St. Vital Centre
Winnipeg, MB, R2M 5R3

We will contact you once we’ve received and reviewed your application.

If you are working with an agency, have them complete the form below as well.

If you are interested in our non-residential counselling services or see below to the online form

    Residential Online Application

    Your Name

    Your Email

    Date of Birth

    Day

    Month

    Year

    Home/Cell Phone

    Alternate Contact

    Is it safe to leave a voicemail?

    Current Address

    How long have you lived at this address?

    Is this current address:

    Who do you live with at your current residence?

    Previous addresses (last 3 years)

    Have you ever applied to the Alpha House program before?

    If yes, what year?

    What are your current sources of income?

    Will this income change within the next 2 months?

    What is your educational background?

    Information about your children (Name, Gender, Birthdate, Grade, Location)

    Are Child and Family Services involved?

    If yes, how long have they been involved?

    Do your children have any serious health/medical problems?

    Do you have any serious health/medical problems?

    Are you pregnant?

    Have you ever struggled with substance use?

    If yes, please describe:

    Have you ever attended a treatment program?

    If yes, provide name of program and dates:

    Information on the abusive partner:
    Name

    Birthdate

    Ethnic background

    Address

    How long have you been in the relationship?

    Have you ever left your partner because of abuse before?

    If yes, when, where did you stay, and how long?

    When did the last violent incident occur?

    What type of violence occurred?

    Have your children ever been abused?

    If yes, describe:

    Are you and/or your children in immediate danger?

    If yes, please elaborate:

    Do you have a protection or prevention order?

    If yes, please describe:

    Have you been in more than one abusive relationship?

    If yes, describe the relationships:

    Were you abused as a child?

    If yes, was it:

    Contact with helping agencies (org, person seen, dates, purpose)

    How do you think Alpha House can help you and your children?

    Questions or concerns about Alpha House:

    I HEREBY AGREE TO THE EXCHANGE OF INFORMATION BETWEEN THE REFERRING AGENCY AND ALPHA HOUSE RELATING TO THE PROCESSING OF THIS APPLICATION.

      Non-Residential Online Application

      Your Name

      Your Email

      Phone Number (Home/Cell)

      Is it safe to leave a voicemail?

      Date of Birth

      Day

      Month

      Year

      Current Address

      How long have you lived at this address?

      Is this address a:

      If ‘other’, please specify:

      Do you currently live with your abuser?

      Information about your children (Name, Gender, Birthdate, Grade, Location)

      Do you require childcare during counselling?

      Allergies/health issues for children (if any)

      Do you have serious health/medical problems?

      Please describe:

      Are you struggling with your mental health?

      If yes, please describe:

      Do you struggle with suicidal thoughts?

      If yes, please describe:

      Have you struggled with substance use?

      If yes, please describe:

      What coping strategies do you use?

      What protection/safety measures are in place?

      Information on abusive partner (Name, Address)

      Duration of relationship

      Are you currently in danger?

      If yes, please describe:

      Do you have a protection or prevention order?

      If yes, please describe:

      Has your abuser stalked you (email, phone, physical)?

      If yes, please describe:

      Have you left your partner before?

      If yes, when, where did you stay, and for how long?

      How can Alpha House help? Counselling goals?

      Availability for sessions (e.g., Monday AM to PM)