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

Date

Current Location/Address

Primary Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Email Address

example@example.com

Section 2: Emergency Contact

Full Name

Relationship to Applicant

Phone Number

Format: (000) 000-0000.

Email Address

example@example.com

Section 3: Residency Preferences

Are you applying for yourself? If no, your name & relationship

Desired Move In Date

Date

Unit Type Preferred, All Are All-Inclusive

Will you be intrested in our food package for an extra $250 a month?

Do you require accessibility accommodations? If yes, please explain

Section 4: Independence & Mobility

Please list all Mental Diagnosis

Are you able to live independently without ongoing medical or personal care assistance?

Do you use any mobility aids?

Do you have any conditions that require special accommodations? If Yes, please explain:

Section 5: Financial Information

What is your Primary Funding Source

What is your Back Up Funding Source

Estimated Monthly Income Range

Are you prepared to provide move in fee (non refundable) fee of $250 plus one month rent ?

Other

Upload Proof of Income

Upload ID

Section 6: Background Information

Input Employment Name, Address, & Number

Have you ever been evicted from a residence? - If Yes, please explain with dates in "other"

Other

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

Other

Are you registered sex offender? If Yes, please explain with dates in "other"

Other

Section 7: Additional Information

Do you have specific housing or lifestyle preferences?

How did you hear about us ?

Do you know anyone that can benefit from our services? How can we reach them?

Section 8: Acknowledgment & Consent

The independent living community does not provide medical, nursing, or personal care services.

What services should we add ?

I certify the information provided is true to the best of my knowledge

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

Other

I consent for my income & employment to be verified.

Other

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.

Screening Call Is The Next Step, What Time Works

Choose Another Date & Time

Would you like to add any further information before you submit your application?

Signature of Applicant or Representative

Today's Date

Date

Your Name

First NameLast Name