• Next Phase Living Intake Form

    Please complete this form to be considered for housing with Next Phase Living. We provide structured independent shared housing for adults who are able to live independently. Each adult seeking housing must be disclosed and may be required to complete an individual screening. Submission of this form does not guarantee acceptance or placement.

  • Basic Information

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Housing Needs

    Please answer the following questions about your housing needs and move-in timeline.

  • What type of housing arrangement are you interested in?*
  • Desired Move -In Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • How soon are you ready to move in?
  • What is your current living situation?*
  • Who are you seeking housing for?*

  • Income & Ability to Pay 

    Please answer honestly.  This information helps determine eligibility.

  • Are you able to provide proof of income?*

  • Background & Final Questions

    Please answer honestly. This information helps determine placement eligibility.

  • Next Phase Living is a structured independent living program with rules and expectations. Are you willing to follow all program guidelines?*
  • Do you currently have any substance use concerns that may affect your ability to follow program rules?*
  • Are you able to independently manage your daily living needs, including personal hygiene, dressing, meals, medications, transportation, and other routine activities without hands-on assistance from Next Phase Living staff?*

  • Please review your responses before submitting.

  • Should be Empty: