• RESIDENT INTAKE FORM

    Application for Single Adult Women, Men, and Veterans Seeking Shared Independent Housing
  • Pretty Unique Haven – Program Overview
    Pretty Unique Haven is a shared independent and transitional housing program that provides safe, stable, and affordable housing opportunities for single adult women, single adult men, and veterans. Our program is designed to support individuals who are working toward greater housing stability, financial independence, and long-term self-sufficiency.

    Our housing model promotes accountability, respect, and personal responsibility while providing a clean, structured, community-based living environment where residents can focus on achieving their personal and professional goals.

    Pretty Unique Haven is not a homeless shelter, medical facility, assisted living facility, treatment center, or emergency housing program. Residents are expected to live independently, manage their own daily responsibilities, maintain employment or a verifiable source of income, and contribute positively to the shared household.

    Housing is provided in fully furnished shared homes with private or shared bedrooms and shared common areas, including the kitchen, living room, bathrooms, and laundry facilities. Placement is based on program eligibility, availability, compatibility with other residents, and the ability to meet program expectations and financial obligations.

    Our goal is to provide a safe foundation where residents can rebuild, grow, and transition into permanent independent housing.

  • Who We Serve
    Pretty Unique Haven welcomes qualified applicants including:

    Single Adult Women
    Single Adult Men
    Veterans
    Individuals transitioning from unstable housing
    Working adults seeking affordable housing
    Individuals rebuilding after life transitions
    Adults committed to living independently in a structured environment

    Important Notice
    Submission of an application is used to determine program eligibility and housing suitability. Completing an application does not guarantee placement. Housing placement depends on availability, verification of eligibility, completion of the screening process, and acceptance into the program.


    Income Requirement & Verification
    Applicants must have a verifiable source of income sufficient to meet monthly program fees and shared

    Applicants must have a verifiable source of income sufficient to meet monthly program fees and shared household expenses. Acceptable income may include:

    Employment
    VA Benefits
    SSI/SSDI
    Retirement Income
    Pension Benefits
    Other verifiable sources of income
    Income verification is required before placement.

    • APPLICANT INFORMATION 
    • Date of Birth
       - -
    • Format: (000) 000-0000.
    • Are there any children? If yes, how many?
    • Number of children:           

    • CURRENT HOUSING STATUS 
    • Current Living Situation:
    • INCOME INFORMATION 
    • Employment Status:
    • Income Source(s):
    • MEDICAL/SUPPORT INFORMATION 
    • Do you have any medical condition staff should be aware of?
    • If Yes, please explain:           

    • Are you currently receiving mental health services?
    • Agency Name/Number               

    • Are you currently receiving TANF/SNAP
    • Health Issues?
    • If Yes, please explain include any medications:           

    • LEGAL INFORMATION 
    • Are you currently on probation/parole?
    • If Yes, please explain:           

    • Do you have pending legal matters
    • If Yes, please explain:           

    • EMERGENCY CONTACT 
    • Format: (000) 000-0000.
    • DOCUMENT CHECKLIST 
    • Deposit & Balance:            

    • *Referral Name:         

    • APPLICANT CERTIFICATION 
    • I certify that the information provided is true and complete to the best of my knowledge.

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