KAA Live Inquiry Form
Name of Primary Contact
First Name
Last Name
Relationship of Primary Contact (if not same as resident)
Mother or Father
Legal Guardian
Conservator/POA
Social Worker/SSA
Own Responsible Party
Other
Best method for receipt or release of information
SMS Text
Email
Enter email address
example@example.com
Enter home phone number
Please enter a valid phone number.
Enter cell phone number
Please enter a valid phone number.
Name of person interested in living in a KAA Community (if name is different than above)
First Name
Last Name
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Current age
18-24
25-29
30-34
35-39
40-44
45-49
50+
Race
White
Black or African American
Asian
American Indian or Alaska Native
Hispanic
Native Hawaiian or Other Pacific Islander
Gender
Man
Woman
Non-Binary
Marital Status
Single
Married
Divorced
Widowed
Employment Status
Not employed
Employed, less than 10 hours per week
Employed, 10-25 hours per week
Employed, full time
Other
Please choose your housing preference in order (1=most desirable to 5=least desirable)
What is your current living arrangement?
Living at home with family
Living in an independent or supported setting in the community with 1 or more roommate(s)
Living in an independent or supported setting in the community with NO ROOMMATE
Other
Do you currently access housing vouchers for rental assistance (if living outside of the family residence?
Yes
No
Other
If living at a family home, what monthly rent payment could you afford to pay (not including utilities) if you were to live in a KAA community?
$500-$750
$750-$950
$950-$1,150
$1,150-$1,350
$1,350-$1,500
$1,500+
If living independently, what is your current monthly rent payment (without utilities)?
$500-$750
$750-$950
$950-$1,150
$1,150-$1,350
$1,350-$1,500
$1,500+
Do you have the ability or interest in purchasing a "tiny home" or a "condominium" and what could you and/or your family afford to buy?
$149,000 or less
$150,000-$175,000
$200,000 +
$175,000-$200,000
non-applicable (if this question does not apply to you)
Other
If you could purchase a "tiny home" or a "condominium", would you purchase a 1-bedroom or a 2-bedroom?
one bedroom
two bedroom
non-applicable (if this question does not apply to you)
Other
If you moved into a residential unit with KAA LIVE Community, would you bring your own furniture or would you require it to be furnished?
Bringing my own furniture
Needs furnished
How much would you be able to pay for a furnished apartment?
Would you be willing to live in (check all that apply).
Anderson
Eastgate
Landen/Montgomery/Loveland
Fairfield
Milford
Downtown/Clifton
Bridgetown
Harrison-Mack
Northern Kentucky
What is your timeframe for housing needs?
0-6 months
6-12 months
12-18 months
18-24 months
2 years +
Other
Will you use or require public transportation via Metro/Metro Access?
Yes
No
Other
Will you need wheelchair accessible transportation?
Yes
No
Other
Will you require daily assistance with housekeeping, laundry, cooking, etc. (if provided by a service provider, please provide the name of the organization in the "other" section)?
Yes
No
Other
Would you participate in a meal program if provided?
Yes
No
What type of personal care would be required?
24/7 care (from a service provider)
Daily care (on a limited basis for a few hours a day from a service provider)
weekly care
None
family- only care
Other
How often would you participate in off-site social activities if planned for residents?
daily
weekly
biweekly
monthly
quarterly
never
Other
What other needs would you like to have met with a KAA LIVE community that are not listed?
Submit
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