• Colorful Welcoming House with a heart at the center

    INTAKE FORM

    Please complete all fields before submitting.

  • Client Information

  • Format: (000) 000-0000.
  •  - -

  • Demographic Information

  • Please indicate your race/ethnicity (select all that apply):

  • Emergency Contact

  • Format: (000) 000-0000.

  • Criminal & Legal History

  • Current or Prior Living Circumstances

  • Current Support Services

  • Substance Use & Health

  • (Please note, the company is not a medical facility and cannot administer medication.)
  • (A staff member can remind you when it's time to take your medication.)

  • Accessibility & Physical Needs

  • Housing Preference

  • Employment & Income

  •  - -

  • Identification & Documents

  • Move-In Timing

  • When are you planning to move?

  • Agreement & Certification

  • Please note, there is a $250 one-time program fee due to hold your requested room.

  • Rent is due the day of move-in and will be prorated if you move in after the 1st of the month.

  • By agreeing below, I certify that the information provided is true and complete to the best of my knowledge. I understand that Sweet Living House is a drug- and alcohol-free environment and that all residents must follow the program rules and policies to remain in good standing.

  •  - -
  • Should be Empty: