Evelyn's Oaks

  • Evelyn's Oaks Independent Living Intake Form

    Fill out the form below to join the waitlist for independent living housing with Evelyn's Oaks. Your information will remain completely confidential.

  • Format: (000) 000-0000.
  • Date of Birth
     / /
  • Gender*
  • Marital Status
  • Do you understand this home is for single occupancy only (one resident per bed/lease)?*
  • Are you requesting housing for anyone other than yourself?*
  • Current Living Situation*
  • Date Housing is Needed*
     / /
  • Sources(s) of Income*
  • Would you be able to provide proof of income?*
  • Payment Plan for Rent*
  • Are you able to live independently without daily assistance?*
  • Do you understand that housing is in shared rooms only?*
  • Do you currently receive help with daily activities(cleaning, cooking,hygiene,etc.) ?*
  • Would you need transportation assistance?
  • Do you have your own vehicle?*
  • Do you have a valid identification card?( Drivers License, State ID, Passport etc;)
  • Do you understand that Evelyn's Oaks is a shared living program, and that by entering this environment you are agreeing to participate in a structured, supportive setting designed to help you build stability, independence, and healthy routines?
  • How do you prefer to be contacted?*
  • Should be Empty: