Sunshine Horizons Independent Living Waitlist Application
*Serious Inquiries Only*
Full Name
*
Date Of Birth:
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Income amount
*
Income source
*
Proof of income available? (Yes/No)
*
How long do you plan to stay?
*
1-3 months
3-6 months
6+ months
Are you applying for
*
Yourself
Someone else
Are you able to follow house rules and maintain a respectful, clean environment?
*
Yes
No
This is a quiet, structured home. Are you comfortable with: •No excessive noise •No parties •Shared responsibilities •Respect for others
*
Yes
No
Do you smoke? Yes/No
*
“I understand this is a structured living environment and agree to follow all house guidelines if selected.”
*
Yes
No
Preferred County for housing: Johnston County or Surrounding areas (please specify: _______)
*
Preferred Move-In- Date:
*
-
Month
-
Day
Year
Date
Additional Notes/ Special Needs:
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Join Our Waitlist
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