Vale & Vine Estates Housing Application

Vale & Vine Estates Housing Application

Professional luxury-style housing application for a structured shared living environment in the East Bay, California. Please complete all sections and review the agreements before submitting.
Applicant Information
Full Legal Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Driver's License or State ID

Cancelof
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Emergency Contact
Housing Information
Desired move-in date

MonthDayYear
Current living situation
Reason for moving
Intended length of stay
Monthly income
Employment status

Other
Employer or income source
Program assistance or benefits

Other
Ability to pay monthly housing consistently
Shared Living Compatibility
Have you lived in shared housing before?
Are you comfortable living in a structured shared environment?
Are you comfortable following house rules?
Describe your typical daily routine.
What goals do you have during your stay?
Are you comfortable participating in house cleanliness expectations?
Are you comfortable respecting quiet hours?
Do you smoke?
Do you drink alcohol?
Have you ever had a history of violence or aggressive behavior?
Do you have any current legal issues that may affect housing stability?
Are you comfortable living where a young child is present?
Do you understand that respectful language and behavior are required at all times?
Recovery & Substance-Free Living
Are you currently in recovery?
How long have you maintained sobriety?
Are you currently participating in any recovery or support programs?
Which substances are you actively avoiding?

Other
What support systems help you maintain stability?
Are you willing to maintain a substance-free living environment?
Do you understand that drug or alcohol use on the property is prohibited?
Safety & Environment
Willing to keep shared spaces clean
Agree to respect all residents and guests
Ever removed from shared housing before
Ever violated housing rules in a previous living situation
How do you typically handle conflict or stress?
What does accountability mean to you in shared living?
References
Previous Landlord Name

First NameLast Name
Previous Landlord Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference Name

First NameLast Name
Personal Reference Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Agreements
Agreement 1
I understand that Vale & Vine Estates is a structured shared living environment that prioritizes safety, respect, cleanliness, accountability, and peaceful community living.
Agreement 2
I understand that drug or alcohol use on the property is strictly prohibited and may result in immediate removal from the program or residence.
Agreement 3
I understand that a $30 non-refundable application and administrative screening fee is required before my application can be reviewed.

Vale & Vine Estates

Application Fee

Application & Background Screening Fee (Non-Refundable)

$30.00

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

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Vale & Vine Estates Housing Application

Applicant Information

Housing Information

Shared Living Compatibility

Recovery & Substance-Free Living

Safety & Environment

References

Agreements

Vale & Vine Estates*

Vale & Vine Estates