Intake Form

We are excited about the opportunity to extend assistance in your time of need.Please review the qualifications before applying for our Affordable Housing Program.

Qualifications

-Can Live Independently- Over the age of 18-Must have a guaranteed verifiable source of income (SSI/SSDI, Veteran Benefits, Program rental assistance, paystub etc.).- Must be willing to abide by all of Rest Assured Residence Rules (see rules below).The client application is for the wait-list and is based on bed and room availability. It does not guarantee a secured room.Once your application has been received, a staff member will be in contact with you soon.

• House Rules

If you've read the above qualifications, and these terms are acceptable to you, please continue to the intake form below.