The Orchard Program Application

  • Program Application Form

    This application is for individuals interested in joining The Orchard Program, a housing initiative in Charlotte that provides safe, affordable, and community-based shared living for adults working toward independence. The information you provide will help us determine eligibility and ensure that our program is the right fit for your needs. Please answer all questions honestly and completely. Submission of this application does not guarantee acceptance into the program. All information will be kept confidential and used solely for program evaluation purposes.
  • Date of Birth*
     - -
  • Gender*
  • Do you have a working phone we can use to contact you? *
  • Do you have an email address?
  • Do you have a current address?
  • Where you referred by: agency, case manager, family member, flyer, etc?

  • Housing Needs

  • Desired move-in date*
     - -
  • Do you have children under the age of 18?*
  • Do your children live with you?*
  • Do you currently have a safe place to stay?*
  • What form of transportation do you use?*
  • What type of room are you looking for? *
  • Are you comfortable sharing a bedroom?*
  • Do you require any accessibility accommodations?*

  • Background and Support

  • Do you have any current or past safety concerns (such as domestic violence) that we should be aware of to ensure your privacy and security needs?*
  • Would you like a private conversation with staff to discuss safety planning or address any special confidentially needs (such as keeping your address confidential or restricted delivery)*
  • Veteran Status*
  • Are you currently on probation or parole?*
  • Are you a registered sex offender?*
  • Do you have a history of violence or property damage?*
  • Do you have a case worker, social worker, or program coordinator?*

  • Employment & Financial Information

  • Current Employment Status*
  • Source of Income*
  • Do you receive food stamps/EBT (SNAP Benefits)*
  • Do you have a payee or representative managing your income?**
  • Ability to pay $250 program enrollment fee?*

  • Health & Wellness

  • Do you have any medical conditions we should be aware of?*
  • Do you have a diagnosed mental health condition?*
  • Are you taking prescribed medication?*
  • Do you need assistance managing medications?*
  • Do you have a primary care provider or clinic?*

  • Substance Use

  • Do you currently use drugs or alcohol?*
  • Do you use tobacco products of any kind?*
  • Have you participated in a substance use treatment program?*
  • Would you like to be connected with recovery support services?*

  • Legal & Safety

  • Have you ever been convicted of a felony?*
  • Do you have any pending court cases?*
  • Are there any restrictions we should be aware of? (curfew, restraining orders, housing restrictions)*

  • Program Participation

  • Are you willing to attend weekly wellness check-ins? (Short conversations with program staff)*
  • Are you comfortable living in a shared housing environment?*

  • Community laws and guidelines.

  • Community Living Guidelines

    • Respect
    • Treat all members, staff, and visitors with dignity.
      No discrimination, harassment, or bullying.
    • Safety & Security
    • No weapons, alcohol, illegal drugs, or criminal activity.
      Cameras in common areas ensure accountability and safety.
    • House Conduct

    Quiet hours: 10:00 pm – 7:00 am.
    Guests must be pre-approved and follow house rules.
    No overnight guests.

    Cleanliness & Responsibilities

    Maximum of two (2) personal bags/luggage.
    Keep personal and shared spaces clean.
    Follow weekly chore schedule.
    Wash personal bedding & towels every week. 
    Respect house property and furnishings.

    Financial Responsibility

    Membership fees are due on the same day of each month.
    Non-payment will result in program removal.
    Wellness & Accountability

    Attend weekly check-ins or meetings.
    Follow program agreements and house manager instructions.
    Report safety or maintenance issues immediately.
    Community Standards

    No violence, threats, or disruptive behavior.
    No smoking inside the house (designated outdoor areas only).
    Uphold honesty and integrity at all times.
    Program ParticipationMembership is a privilege, not a right. Continued housing depends on following guidelines and contributing positively to the community. Failure to comply may result in removal from the program.

  • Are you willing to follow community rules and guidelines?*

  • Acknowledgment

  • Acknowledgment (required checkbox)*
  • Today's date*
     - -
  • Should be Empty: