Check Housing Eligibility- Adult Housing Assessment

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CHECK HOUSING ELIGIBILITY – ADULT HOUSING ASSESSMENT

Magnolia Heritage Home Solutions provides independent housing for Individual Adults who can live independently but benefit from a safe and supportive community environment. Please complete the short assessment below so we can determine whether our Independent Living Community may be a good fit.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date

MonthDayYear
Date
Do you have your own transportation?
How soon are you needing to move?
Are you local or are you relocating from another state?
As a part of our standard application process, we do require a valid government-issued ID (such as a driver's license or state ID) along with your income verification documents. This helps us ensure accuracy and complete your approval.

Please upload a photo of the front and back of your Driver's License or State ID below.
DRIVERS' LICENSE FRONT & BACK OR STATE ID UPLOAD HERE

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Are you willing to live in a shared living home?
SSI (Supplemental Security Income)SSDI (Social Security Disability Insurance)SS RetirementSS Survivors (Widow/Widower benefits)VA DisabilityVA PensionEmployment Income (Full-time/ Part-time)Self EmploymentPensions (State, Private, or Military)401(k)/IRA withdrawalsPrivate Pay (out-of-pocket or family payments)Other
If you are receiving income benefits, we will need to verify your income to complete your housing approval. We require your official Benefit Verification Letter from Social Security. This shows your exact monthly income and allows us to finalize your eligibility.

Do you agree to provide your Benefit Verification Letter?
In addition to providing your Social Security Benefit Verification Letter (required if applicable), all applicants must provide verifiable proof of income before approval, including: 1.) 2-3 months of bank statements 2.)Any additional income documentation (pension, VA, etc.). *Applicants will not be approved without complete and verifiable income. Please sign below to indicate your agreement to provide these documents for approval before proceeding.
Signature
PLEASE UPLOAD BELOW-----Your Verification Documents below: 2-3 months' bank statements, Benefits Verification Letter, and any additional income verification documents.

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Please verify that you are human*
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CHECK HOUSING ELIGIBILITY – ADULT HOUSING ASSESSMENT