Join Our Community

We look forward to hearing from you, I'd love to give you some more information regarding our independent living housing program:

We offer affordable, supportive housing to individuals that are able to live independently in a family style setting.

We offer both shared and private rooms and provide the following inside of our homes: Brand new comfortable bedding, toiletries, cleaning supplies, laundry detergent, all appliances (including washer/dryer) high speed WiFi, high definition TV’s in every single room, a welcome pack with hygiene items, and the home is fully furnished from top to bottom.

In addition to all inclusive housing, we also provide the following services: Weekly shopping assistance, medical appointment and transportation scheduling, medication reminders, and we have a live in house manager there to serve our clients.

Clients are responsible for their own meals and grocery items. Each resident is provided with designated pantry and refrigerator space for food storage. In addition, we provide varied meal options throughout the week as part of our supportive living environment.

Our main goal is to make sure our clients have a peaceful home that they can relax and enjoy themselves.

Initial Interest

Are you interested in moving forward? If so, we can begin the assessment to determine eligibility.

Referral Information

Do you have a case manager? If yes, please provide their full name, phone number, email, and organization.

Client Information

What is your full name?

What is your gender?

Desired move in date

What's The Best Phone Number & Email For You? We'll send over photos and details of our homes.

Your Date of Birth?

Last 4 digits of Social Security Number (Required for background check):

Height and weight

Current or most recent address

Reason for leaving your current or last residence

Identification and Income

Driver's License number or State ID number? If not put N/A

Do you currently receive any government assistance (EBT, General Relief, Cash Aid, etc.)? If yes, please list:

What is your primary source of income? (e.g., SSI, SSDI, VA benefits, employment, family support, etc.)

Emergency Contact / Payee

Please provide the name and contact information of your emergency contact or payee:

Funding & Referral Support

Are you receiving housing assistance through an organization? (e.g., HHOPE, Illumination, VA, etc.)

Health & Support Needs

Do you have any physical health conditions?

Do you require any special assistance with daily living tasks?

Do you have any mental health diagnosis?

Are you currently taking any medications? Do you need medication reminders?

Do you have any known allergies:

What is your current medical insurance?

Safety and Background

Have you ever experienced thoughts of self-harm or suicide? Have you ever attempted suicide? If yes, please provide details below.

Have you ever been arrested, charged or convicted of a crime or felony? Please explain (Details needed - Where/When/Charge/Time Served etc..)

Substance Use

Have you ever used the following substances:. Marijuana, Methamphetamine, Opioids, Opiates, Heroine, Fentanyl or any controlled substance or street drug? Please explain. When was your last use?

Do you use tobacco or alcohol?

Additional Information

Any questions or concerns?

We look forward to hearing from you, I'd love to give you some more information regarding our independent living housing program:

Discover independent living with heart. Our care home offers more than housing —

We provide a caring community, security, and support for those who need it most

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