Oak and Maple Living Intake Form
Please complete the form below to be added to the waitlist for private and shared room rentals with Oak & Maple Living. All information submitted will remain confidential.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date Of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non-Binary
Prefer not to say
Martial Status
Single
Married
Divorced
Do you understand that this home is for single occupancy only ( one person per bed/agreement)
Yes, I Understand
No, I have a child(ren)
No, We are a couple
Will any children be residing in the home? (under the age of 18)
Yes
No
If YES, Number of children:
Ages of children:
Will the children be residing in the home full-time or part-time?
Full-Time
Part-Time
Occasional visits only
I understand that Oak & Maple Living is a shared residential home and that any children residing in or visiting the home must be supervised by their parent or legal guardian at all times.
Yes, I understand and Agree
No, I don't understand
Not Applicable
I understand that room assignments, occupancy limits, and acceptance are based on space availability, household compatibility, and safety considerations.
Yes, I understand
No, I don't understand
Are you requesting housing for anyone other than yourself?
Yes
No
If YES, who?
Are you and another individual that you know is requesting housing at a Oak and Maple Living Home?
Yes
No
If Yes, What is the person's first and last name and can they provide identification? (persons over the age of 18)
If applicable, Will this person be requesting to share the room with you? (spouse, sibling, child over the age of 18, and/or friend)
Yes
No
If No, please have this person that is over the age of 18 submit a separate intake form with Oak and Maple Living to be considered for the room requested. (if applicable)
Current Living Situation?
Homeless
Living with family/friends
Shelter
Transitional Housing
Treatment Center
Jail/Prison Release
Other
Current Address (If Applicable)
Referral Agency/Source
How did you hear about us?
Date Housing is Needed? Please keep mind that if you are inquiring about our newly renovated Decatur home. The move in date will be no sooner than 03/02/2026 but you will be contacted regarding next steps and notified of what is available and placed on our waitlist. You can also visit our website to learn more about us at https://oakandmapleliving.com
If you would like to be placed on our waiting list and not interested in moving right away, Please Type “waiting list” so that we can accommodate accordingly. If you are looking to move within the next few days to 2 weeks, please type desired move-in date.
How long do you anticipate needing housing?
1-3 Months
3-6 Months
6+ Months
Unsure
Source(s) of Income
Employment
SSI/SSDI
Unemployment benefits
Family/Friends
Would you be able to provide proof of income?
Yes
No
Monthly Income
I understand that rent is due every month in full and that timely payment is required to maintain my housing at Oak & Maple Living.
Yes
No
Are you able to live independently without daily assistance?
Yes
No
Do you have your own vehicle?
Yes
No
I acknowledge that Oak & Maple Living provides housing accommodations only and does not offer medical care, personal assistance, supervision, or supportive services.
Yes
No
I understand that Oak & Maple Living offers both private and shared living arrangements within a residential home. Depending on the room assigned, I may occupy a private room or a shared room with another resident. NOTE: If you have multiple children or a child, a private room is recommended but contingent upon availability.
Yes, I am open to what is available.
No, I only prefer a private room with shared bath, shared with one other occupant for $200/week
No, I only prefer a private room with a private bath(master) shared with one other occupant for $225/week
No, I only prefer a private room with a shared bath, shared with no one else for $275-300/week
To secure the room requested, the fees must be paid in full before move-in. This is the next steps after completing this intake form- upon availability and household fit. Please reply “I understand and agree” to acknowledge this requirement.
Deposit fees and the full payment of the first month's rent is required to secure the room. Rent is also applicable to be prorated if you move after the 1st of the month requested. Please reply "I understand and agree" to acknowledge this statement.
Do you require a private room due to having children?
Yes
No
If Yes, How many and what are the ages? (N/A)
Do you currently receive help with daily activities( cooking, cleaning ,hygiene ,etc?)
Yes
No
Do you have a valid identification card? (Driver's License, State ID, Passport etc?)
Yes
No
I acknowledge and agree to comply with established quiet hours, which are intended to support a peaceful living environment for all residents. During quiet hours, residents and their guests—including children—are expected to keep noise at a reasonable level, including voices, television, music, and shared space use.
Yes
No
How do you prefer to be contacted?
Phone
Text
Email
I consent to be contacted regarding my housing inquiry via my selected communication method.
Yes
No
Do you agree to follow the home’s no-illegal-substances policy?
Yes
No
Criminal Background Disclosure: Do you have any convictions that may affect shared housing eligibility?
Yes
No
Prefer Not to Discuss
If YES, What?
Background Screening Acknowledgment: There is NO background or credit screening that will be conducted at this moment but we do ask for full transparency regarding your living situations(past and present); when asked or convictions. Oak and Maple living want to ensure our guests are comfortable, safe, and able to pay for their requested room. We aim to provide affordability, safety and a peace of mind to everyone who request for housing from us so communication is important. Please reply "I understand and agree" to acknowledge this statement.
Special Considerations: Is there anything you would like us to know to help ensure a good household fit? Please Explain.
I understand and agree to comply with all house rules, policies, and safety standards set forth by Oak & Maple Living. I understand that Oak & Maple Living reserves the right to enforce all house rules and safety policies in accordance with applicable Georgia housing laws. I acknowledge that violations involving safety, illegal activity, or conduct that disrupts the household may result in immediate termination of the living agreement with written or verbal notice. In such cases, I understand that I may be required to vacate the premises within 24 hours and remove all personal belongings.
Yes, I understand and agree
No, I don't understand
I understand that non-emergency violations may result in written and verbal notice and an opportunity to correct the issue, while serious or safety-related violations may result in immediate termination of my living arrangement which will require me to vacate the home immediately.
Yes, I understand
No, I don't understand
I acknowledge that any behavior involving violence, threats, illegal substances, weapons, or actions that place others at risk may result in immediate removal from the home immediately.
Yes, I understand
No, I don't understand
Oak & Maple Living requires all residents to maintain active renter’s insurance coverage for the duration of their stay. This insurance protects your personal belongings and provides liability coverage. As a convenience, Oak & Maple Living offers renter’s insurance coverage options, which will be presented to you. Enrollment in renter’s insurance and signing the renter’s insurance acknowledgment document is required as part of your move-in process. This document must be signed prior to or at the time of move-in. Oak & Maple Living is not responsible for loss, theft, damage, or destruction of personal property.
Yes, I understand
No, I don't understand
I understand and agree to sign the required renter’s insurance document prior to move-in provided by Oak and Maple Living.
Yes
No
Please verify that you are human
*
Signature
Today’s Date
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Month
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Day
Year
Date
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