Waiting List

Housing Waiting List

Thank you for your interest in Myrtle Clay Community Living. This form allows individuals and families to express interest in upcoming residential availability across our Dallas–Fort Worth locations. Submitting this form does not guarantee placement but helps us better understand housing needs and contact you when space becomes available. All information provided will remain confidential. For immediate availability inquiries:📞 972-433-7171✉ Info@myrtleclayliving.com
Residence Waiting List

Please fill out the below information
Housing Options

Sober LivingIndependent LivingVeterans Living
Contact Information

Share your current contact details so we can reach you.
Full legal name*

First NameLast Name
Preferred name
Date of birth*

MonthDayYear
Date
Gender

FemaleMaleNon-binaryPrefer not to sayOther
Current Housing Status

• Homeless / Shelter• Transitional Housing• Temporary stay with family/friendsOther
Current address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone number*
Please enter a valid phone number.
Email address*
example@example.com
Representative Information (if applicable)

First NameLast Name
Relationship to Applicant
Phone number*
Please enter a valid phone number.
Email address*
example@example.com
General Support Needs (non-medical)*

Life skills supportCommunity integrationDaily living organizationEmployment or education support (non-clinical)Social engagementTransportation coordinationOther
When are services or housing needed?*

ImmediatelyWithin 1–3 monthsWithin 3–6 monthsFuture / Not sure
Who is completing this form?*

I am applying for myselfFamily Member or authorized supportShelter or community agencyHospital or treatment programOutreach workerCase manager / social workerOther
Brief space for applicant or family to share goals or concerns
Why are you interested in The Myrtle Clay Community Living?
Preferred method of contact*

Phone callText messageEmailMail
Consent & Acknowledgment
Consent and Acknowledgment*

I understand that submission of this form does not guarantee placement and that information provided will be used to contact me regarding availability.
Applicant signature (typed)*
Date*

MonthDayYear
Date
Should be Empty:

Housing Waiting List

Residence Waiting List

Contact Information

Consent & Acknowledgment