/ 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 with the counselling team for one-on-one support & engaging in group therapy for psychoeducation and peer support
  • 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

Alpha House staff will only reach out to suitable applicants; for an update on the status of your application, please call us.

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

    Contact Form

    Your Name

    Your Email

    Your Phone

    Date of Birth

    Day

    Month

    Year

    Current Address

    Is your current address:

    Who do you live with in your current residence? Include their names and relationship to you.

    Previous addresses for the last three years? Include addresses and length of time at each address.

    Have you ever been a tenant of Winnipeg Regional Housing Authority?

    If yes, please indicate when, where and the reasons for moving.

    Have you ever applied to the Alpha House program before?

    If yes, what year?

    Day

    Month

    Year

    What is your ethnic background or heritage?

    What languages do you speak?

    Do you need a translator?

    Please provide some information about your children. Include their names, gender, birthdates, grade, and location.

    Do your children have any serious health/medical problems?

    Do you have any serious health/medical problems?

    Are you pregnant?

    What are your current sources of income?

    Will this income change within the next 2 months?

    Please explain:

    If employed or in training outside the home, please provide the following:

    Employer’s name and address:

    Employer’s phone number:

    Employer’s hours and type of work:

    What is your educational background?

    Degree, diploma, or trade:

    Please provide some information on the abusive partner:

    Name:

    Birthdate:

    Day

    Month

    Year

    Ethnic Background:

    Address:

    Most recent violence:

    When did the last violent incident occur?

    What type of violence occurred?

    Was a weapon used in any of the assaults?

    What type of weapon?

    How often were you abused?

    Are you in immediate danger at this time?

    History of violence:

    Have you been involved in more than one abusive relationship?

    If yes, please tell us about these relationships. Include Name, Length of Relationship, Type of Abuse

    Were you abused as a child?

    If yes, was the abuse:

    Have your children ever been abused?

    Please describe what happened:

    Are your children in immediate danger?

    Are Child & Family Services involved?

    Do you have a restraining order?

    Please describe:

    Have you ever left your partner because of abuse?

    If yes, please indicate when:

    Day

    Month

    Year

    Where did you stay?

    Length of time away?

    Please provide us with some information about you or your family’s contact with any helping agencies, including counselling, groups, social services, police, legal, or others. List the organization, person seen, dates, and purpose.

    Do you have a history of alcohol or other drug abuse?

    If yes, please describe:

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

    Do you have any questions or concerns about Alpha House? Please list them below:

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

     

    For Non-Residential Counselling

     

      Non-Residential Counselling Application

      Submit options:
      Complete online, email to womenscounsellor@alphahouseproject.ca,
      fax to 204-254-2602, or mail to Alpha House P.O. Box 37015 RPO St. Vital Centre Winnipeg, MB R2M 5R3

      Name

      Email

      Date of Birth

      Day

      Month

      Year

      Phone Number: Home/Cell

      Is it safe to leave a voicemail at this number?

      Current Address (at time of application)

      How long have you lived at this address?

      Is this current address:

      Do you currently live with your abuser?

      Children Information


      Please provide information about your children (names, genders, birthdates, grades, and locations):

      Do you require childcare during your counselling sessions?

      If yes, do your children have any allergies, serious health, or medical problems? Please list:

      Health Information

      Do you have any serious health/medical problems?

      Are you currently struggling with your mental health?

      Do you struggle with thoughts of suicide?

      Have you ever struggled with substance use?

      What coping strategies do you use? How do you take care of yourself emotionally?

      Safety Information


      What protection planning/safety measures do you have in place?
      (e.g., new phone, changed email/social media, new address/school, secured documents)

      Please provide information about the abusive partner (name and address):

      How long have you been in/were you in the relationship?

      Are you currently in danger?

      Do you have a protection order or a prevention order?

      Has your abuser ever used stalking behavior such as monitoring your emails, social media, tracking your phone, or physically following you/your children?

      Have you ever previously left your partner because of abuse?


      If yes, please provide details of when you left, where you stayed, and length of time away:

      How do you think Alpha House non-residential counselling can help you and your children? What are some of your counselling goals?

      Availability


      Our program runs M-Th 9am-4pm and F 9am-2:30pm. Please describe your availability during these hours:

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

      Sign

      Date