Prescreen & Intake Application

Complete this short form to begin the process. We'll review your information and reach out within 1–2 business days.

◆

Personal Information

Fields marked with * are required.

Full Name

Email Address

Phone Number

Date of Birth

Gender

Housing & Background

Are you a veteran?

Current Housing Situation

Were you referred by an organization?

If yes, which organization referred you?

Eligibility Questions

Do you receive income?

Are you able to live independently and take care of yourself?

Are you comfortable living with other adults in shared housing?

Do you have any criminal history or current legal issues?

Do you have any pets?

Do you smoke or use alcohol or other substances?

Are you willing to follow house rules? (No guests, no drugs, quiet hours, etc.)

Is there anything else you'd like us to know about your situation?

Your information is kept confidential and used only for housing placement purposes.