Statement of Interest

Statement of Interest

Thanks for your interest in Solon Community Living! Please read and complete below. Questions? Contact Director@SolonCommunityLiving.org
Statement of Interest

Please complete the information below to submit and request contact and discussion on potentially living at Solon Community Living!
Primary Contact Name

First NameLast Name
E-mail
example@example.com
Primary Contact Phone Number
Format: (000) 000-0000.
Preferred Method of Contact
Potential Resident Information

All information beyond this point is regarding the potential future resident of Solon Community Living.
Potential Resident Name

First NameLast Name
Date of Birth:

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you presently receiving waiver services?
Do you have an assigned SSA (Service and Support Administrator) from your county board?
Where do you presently live?

Other
Do you have a legal guardian?
When are you looking to move?
How did you hear about Solon Community Living?
Additional Comments:
Please note: This is not an application for Solon Community Living.

You should receive contact within two business days from someone with Solon Community Living. Did you miss our call or email? Reach out to us at Director@SolonCommunityLiving.org!
Should be Empty: