SLS HOME SOLUTIONS

Section 1: Applicant Information
Thank you for your interest in our Independent Living Program.

We provide independent, non-licensed housing for adults who can live safely without 24/7 care in DMV area. Please complete this application & our House Manager will reach out within 48 hours.
Full Name*
Date of Birth*

MonthDayYear
Date
Current Location/Address*
Primary Phone Number*
Secondary Phone Number
Email Address
example@example.com
Section 2: Emergency Contact
Full Name
Relationship to Applicant
Phone Number
Email Address
example@example.com
Section 3: Residency Preferences
Are you applying for yourself? If no, your name & relationship*
Desired Move In Date*

MonthDayYear
Date
Unit Type Preferred*

Shared SuitePrivate RoomANY
Do you require accessibility accommodations? If yes, please explain *
Section 4: Independence & Mobility
Are you able to live independently without ongoing medical or personal care assistance?*

YESNO
Do you use any mobility aids?*

NOWalkerWheelchairCaneOther
Do you have any conditions that require special accommodations? If Yes, please explain:*
Section 5: Financial Information
What is your Primary Funding Source

Private PayFamily AssistanceSocial SecuritySSDIOther
Estimated Monthly Income Range

Under $1,000$1,000- $2,500$2,500-$4,000Over $4,000
Are you prepared to provide security deposits or required fees?

YESNOOther
Upload Proff of Income

Cancelof
Section 6: Background Information
Have you ever been evicted from a residence? - If Yes, please explain with dates in "other"

NOOther
Have you been convicted of a felony? If Yes, please explain with dates in "other"

NOOther
Section 7: Additional Information
Do you have specific housing or lifestyle preferences?
How did you hear about us ?*
Section 8: Acknowledgment & Consent
The independent living community does not provide medical, nursing, or personal care services.*

I understandI need more services
What services should we add ?
I certify the information provided is true to the best of my knowledge*

YESNO
I consent to be contacted regarding available units or updates on my application.*

YESNOOther
I understand submitting this application does not guarantee housing and that eligibility is based on the facility's ability to safely accommodate independent, structured residents.*

Yes, I fully understand
Screening Call Is The Next Step, What Time Works
What Other Date & Time Works
Would you like to add any further information before you submit your application?
Signature of Applicant or Representative*

Clear
Date

MonthDayYear
Date
Name

First NameLast Name
Should be Empty: