Touchstone Housing Application

APPLICANT INFORMATION
Full Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Current or Most Recent Address*
Phone Number*
E-mail*
example@example.com
Do you have a car?*

YesNo
What is the Make, Model and license plate number?*
Driver's License

NumberState
Do you smoke?*

YesNo
Do you or your spouse have any kids?*

YesNo
How Many and what are their ages?

How ManyAges
Do you have any special needs or requirements the we need to be aware of?*

YesNo
Please be specific:

Roommate Compatibility and Hygiene
Have you ever lived with a roommate and shared a room with bunk beds?*

YesNo
Are you comfortable with following established room cleanliness and tidiness guidelines, such as a cleaning schedule or roommate agreement??*

YesNo
How do you ensure personal hygiene and cleanliness when sharing a room with others*

Emergency Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

CRIMINAL HISTORY
Are you currently on probation or parole?*

YesNo
Please explain. *
Have you, ever been charged (whether or not resulting in a convicted, or pleaded guilty or "no contest" to a felony?*

YesNo
Please explain. *
Have you ever been convicted of or pleaded guilty or "no contest" to a misdemeanor involving sexual misconduct or the manufacturing of drugs whether or not resulting in a conviction?*

YesNo
Please explain.*
Are you required to register as a Violent or Sex Offender in a jurisdiction?*

YesNo
Please explain.*

Behavioral History
Do you have a history of attempted suicide or thoughts of suicide?*

YesNo
Please explain*
Do you have a history of violent or assaultive behavior?*

YesNo
Please explain*
Do you have a history of malicious behavior such as fire setting or retaliation?*

YesNo
Please explain*

EMPLOYMENT INFORMATION

(Current and/or Most Recent Type N/A if this does not apply)
Are you currently employed or previously employed?*

CurrentlyPreviously
1. Present or Previous Employer*
City*
State*
Position*
End Date*

MonthDayYear
Date
Monthly Income*

ATTESTATION
If accepted, I understand that there will be house specific rules and expectations while I am staying at Pathway Solutions LLC.*

I agree with all the terms of this application and am willing to comply with the rules and expectations
At Pathway Solutions LLC , we maintain a strict No Contraband and Drug-Free Zone policy. All applicants, residents, and visitors must adhere to this policy, promoting a safe and healthy environment for everyone. Violations may result in consequences, including termination of association*

I agree with all the terms of this application and am willing to comply with the rules and expectations.
There is a $275 one-time fee that is NOT REFUNDABLE, plus program fees for at least two weeks. EVERYTHING IS DUE ON THE DAY OF MOVE-IN.*

I agree with all the terms of this application and am willing to comply with the rules and expectations.
I hereby certify that the answers I have given in the application are true to the best of my knowledge. I understand that any false answers or statements made by me will be sufficient grounds for including termination of association and removal from Reintegration Haven homes. I agree to a credit check if deemed necessary. I agree that my present employer may release information related to my current income status to the landlord. It is understood that I will not be discriminated against based on race, color, sex, religion, or national origin.
APPLICANT'S SIGNATURE*

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PRINT FULL NAME*

First NameMiddle NameLast Name
Today's Date

MonthDayYear
Our partner REINTEGRATION HAVEN HOMES

(773) 234-6253
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Pathway Solutions LLC

Only 18 and up can apply

* No pets allowed*

APPLICANT INFORMATION

Roommate Compatibility and Hygiene

Self-Identification

Emergency Contact Information

Covid 19 Screening- Current health conditions

CRIMINAL HISTORY

Behavioral History

Substance Abuse History

EMPLOYMENT INFORMATION

Resources/Assistance/Methods of payment

ATTESTATION

Our partner REINTEGRATION HAVEN HOMES

Pathway Solutions LLC

Only 18 and up can apply

*** No pets allowed***

APPLICANT INFORMATION

Roommate Compatibility and Hygiene

Self-Identification

Emergency Contact Information

Covid 19 Screening- Current health conditions

CRIMINAL HISTORY

Behavioral History

Substance Abuse History

EMPLOYMENT INFORMATION

Resources/Assistance/Methods of payment

ATTESTATION

Our partner REINTEGRATION HAVEN HOMES

* No pets allowed*