SIL Application

SIL Applicant
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Number where you can be reached.
Email*
example@example.com
SIL Locations Preferred.

Fort WorthDallasCrowley
Move In Date*
Are you 18 or older?*

YesNo
What is your gender?*

MaleFemale
What is your sexual orientation?*

StraightBisexualLesbianGay
How do you feel about having a roommate?*

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
I am able to follow chore schedule and keep house clean without supervision.*

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
I know how to respect other boundaries and choices.*

Strongly AgreeAgreeDisagreeStrongly Disagree
I get upset easily.*

Strongly AgreeAgreeDisagreeStrongly Disagree
Have you ever destroyed any property?*

YesNo
Have you ever had an sexual allegations against you?*

YesNo
Are you currently enrolled into school or have a job?*

I am currently enrolled into schoolI am EmployedNoI am currently seeking Employment/Education
Do you have any pending criminal charges?*

YesNo
Do you have any medical diganoised conditions?*

YesNoI Do Not Know
Are you currently taking an Meds?*

YesNo
Do you use or have you ever used illegal drugs?*

YesOccasionallyExperimentNo I never use drugs.
I like to consume Alcohol Beverages.*

YesOccasionallyJust DependsNo I never had a alcohol beverage
I take things that does not belong to me.*

Strongly AgreeAgreeSometimesDisagreeStrongly Disagree
I am only applying for SIL because I have no other choice.*

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
Once accepted into SIL Program, if for any reason contract and rules are broken and I am asked to leave, depending on severity of situation, I will leave same day if asked, or by the timeframe given by the Director.*

I AgreeI Do Not AgreeOpen for Discussion
Are you willing to participate in programs and activities provided by the SIL provider including life skills?*

YesNo
Visitors, Alcohol, Drugs are Prohibited and a standard curfew is given with approved exceptions. Failure to comply may result in immediate eviction.*

I AgreeI Do Not Agree
I have reviewed Valuing Other Lives website, and received all the information pertaining to SIL Program and other services that are provided.*

I was able to review websiteI did not review webiste.I have questions regarding website.
Request Move in Date
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SIL Applicant