Apply APPLICATION FORM Application Email * Application Phone number * Who referred you? * What location are you looking for? * Are you aware that this is a shared living * YesNo Gender * FemaleMale Date of Birth * Current Living situation * Current Address * How long are you planning to stay? * Funding Source * Self PayVoucherSocial Security InsuranceSocial Security Disability InsuranceGovernment or State OrganizationNon Profit Organization - Rent Assistance Are you employed? * YesNo Where are you working? * What are your working / hour shifts? * Would you consider a representative payee to ensure timely payments? If not your rent will be due in advance in good faith. * YESNO How much is your monthly income? * How often do you get paid? * Any medical condition? * YesNo Are you taking any medication? * YesNo Do you agree to a drug testing before moving date and random? * YesNo Do you smoke? * YesNo If yes what do you smoke? Can you abide by the rules and regulations to ensure safety and harmony of the home? * YesNo Primary mode of transportation * Any criminal charges, convictions and the nature of charges and any associated outcomes? * YesNo Preferred move in date *
