• Program Application

  • Today's date*
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  • Date of Birth*
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  • Please Note: Age and Household Eligibility

    Sable Haven is an adult-only independent living program for individuals ages 18 and older. We are unable to accommodate minors under the age of 18, including dependent children.

  • Do we have permission to email, text or leave a message on the number provided?*
  • Gender*
  • This form is being completed by*
  • Are you interested in referring this client to Sable Haven’s Emergency Rehousing Program? The Emergency Rehousing Program is available for agency-sponsored or approved third-party funded placements.*
  • What best describes your current living situation?*
  • Referral Source (If Applicable)*
  • Preferred Move In Date*
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  • Desired Housing Location*
  • If immediate housing is unavailable through Sable Haven Independent Living, does the applicant give permission for Sable Haven to refer them to other similar housing programs or community resources that may be able to assist with their housing needs?*
  • Is the applicant currently receiving mental health services or support that they plan to continue while participating in Sable Haven Independent Living?*
  • Does the applicant have a history of alcohol or substance use, including past or current substance use?*
  • I acknowledge and understand that Sable Haven Independent Living is a drug and alcohol free program. All participants are required to comply with this policy throughout their participation in the program. If completing this application on behalf of another individual, I agree to communicate this requirement to the applicant.*
  • Does the applicant anticipate bringing an animal to the residence if accepted into the program?*
  • If yes, please indicate:

  • Note: Sable Haven complies with all applicable federal, state, and local fair housing laws regarding service animals and emotional support animals. Additional documentation may be requested for emotional support animals when permitted by law.

  • Is the applicant currently on parole, probation, or under any other form of legal supervision that may involve housing requirements or residency restrictions?*
  • Is the applicant currently required to register as a sex offender or subject to any court-ordered or legally mandated residency restrictions?*
  • Does the applicant currently have a verifiable source of income sufficient to cover the monthly program fee?*

  • *Note: To be eligible for housing with Sable Haven Independent Living, all applicants must have a verifiable source of income. This may include employment, SSI, SSDI, VA benefits, retirement income, agency or program sponsorship, or another documented source of income. Income verification is required before admission.*

  • Income Source*
  • Is the applicant able to provide current documentation verifying their income, such as recent pay stubs, SSI/SSDI award letters, VA benefits, pension statements, or other acceptable proof of income?*
  • Preferred Room Type*
  • Sable Haven Independent Living is an independent housing program and does not provide assistance with activities of daily living (ADLs). Is the applicant able to independently perform all activities of daily living, including bathing, dressing, toileting, transferring, eating, and personal hygiene, without assistance from another person?*
  • Does the applicant currently receive assistance from a home health agency, personal care attendant, or other supportive service provider?*
  • I understand that Sable Haven Independent Living is a housing program and does not provide medical care, personal care, supervision, or assistance with activities of daily living. All participants are responsible for independently managing their personal care, medical needs, medications, transportation, and daily living tasks. If completing this application on behalf of another individual, I agree to communicate these expectations to the applicant.*
  • I understand that, if accepted into the program, all participants are expected to follow established house rules, program guidelines, and participate in required meetings, case management services, or program-related check-ins. If completing this application on behalf of another individual, I agree to communicate these expectations to the applicant.*
  • I understand that all participants of Sable Haven Independent Living are required to comply with established house rules and program expectations. Failure to comply may result in disciplinary action, including the issuance of a strike or dismissal from the program.*
  • I certify that the information provided in this application is accurate and complete to the best of my knowledge. I understand that submitting this application does not guarantee acceptance or placement with Sable Haven Independent Living, LLC. All applications are subject to review, eligibility verification, and program availability. If I am completing this application on behalf of another individual, I confirm that I have the applicant's permission or other appropriate authority to submit the information provided.*
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