• Resident Intake and Housing Application

  • Thank you for your interest in Next Mission Living. We provide safe, structured, and substance-free independent living housing for veterans and adults who are ready to work toward stability and long-term independence.

    This application is used for initial screening only. Submission does not guarantee acceptance or housing availability. Next Mission Living is not a medical facility, detoxification center, assisted living facility, or provider of hands-on personal care.

  • BASIC ELIGIBILITY

  • Applicants must be at least 27 years of age to qualify. Are you 27 years of age or older?*

  • Applicants must be at least 27 years of age to qualify.

  • 2. Which best describes you?*
  • 3. Are you able to live independently without 24-hour supervision or hands-on personal care?
  • 4. Do you require assistance with bathing, dressing, toileting, feeding, transferring, or other daily personal care?
  • Will you have a nurse aid?

  • Next Mission Living provides independent housing and does not provide assisted living, nursing care, medication administration, or hands-on personal care. Based on this response, our program may not be appropriate for your current needs.

  • 5. Are you willing and able to live in a completely drug-free and alcohol-free home?

  • Maintaining a drug-free and alcohol-free home is a mandatory condition of residency.

  • 6. How soon do you need housing?
  • 7. What type of room would you consider?

  • APPLICANT INFORMATION

  • Date of birth
     - -
  • Format: (000) 000-0000.
  • Preferred contact method:
  • Do you currently have a valid government-issued photo ID?

  • MILITARY STATUS

  • 1. Branch of service
  • 3. Discharge status
  • 4. Do you have a copy of your DD-214 or other military documentation?
  • 5. Are you enrolled in VA healthcare?
  • 6. Do you receive VA benefits?
  • 7. What type of VA benefits do you receive?
  • 8. Do you have a VA case manager, social worker, or housing specialist?
  • Format: (000) 000-0000.
  • 9. Are you service-connected?

  • CURRENT HOUSING SITUATION

  • 1. What best describes where you are currently staying?
  • 3. What date must you leave your current location?
     - -
  • 4. Have you ever been evicted?
  • 5. Have you ever been asked to leave or discharged from a shelter, transitional home, sober living home, recovery residence, group home, or independent living program?
  • Approximate date
     - -
  • 6. Do you currently owe money to a prior landlord or housing program?
  • 7. Do you have any pets or service animals?*

  • EMPLOYMENT, INCOME, AND FINANCIAL READINESS

  • 1. Current employment status
  • 4. Employment start date
     - -
  • 9. List all current income sources
  • How would you like to provide your proof of income?
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  • 12. Which proof can you provide?
  • 13. Can you consistently pay the required housing or program fee by the due date?
  • 14. Do you currently have funds available for your first payment or move-in expenses?
  • 15. Is an agency, case manager, family member, or other organization helping pay your housing costs?
  • Format: (000) 000-0000.
  • 16. Who currently manages your finances?

  • SOBRIETY AND SUBSTANCE-FREE LIVING

  • Next Mission Living maintains a drug-free and alcohol-free residential environment. Honest answers help us determine whether our housing model is appropriate. Responses will be reviewed privately.

  • 1. Have you consumed alcohol during the past 30 days?
  • 2. Have you used illegal drugs, or non-prescribed controlled substances during the past 30 days?
  • Date of most recent use
     - -
  • 4. Do you currently consider yourself to be in recovery from alcohol or substance use?
  • 5. How long have you maintained continuous sobriety?
  • 6. Have you participated in treatment?
  • 7. Are you currently enrolled in or recently discharged from a treatment or recovery program?
  • Format: (000) 000-0000.
  • admission date
     - -
  • discharge date
     - -
  • 8. Do you currently attend recovery support meetings?
  • 9. Do you have a sponsor, peer specialist, counselor, or recovery coach?
  • 10. Are you willing to comply with reasonable substance-free housing policies, including testing when permitted by program policy and applicable law?
  • 11. Are you willing to report a relapse or return to use promptly so that safety and next steps can be addressed?
  • 12. Are you currently experiencing withdrawal symptoms or in need of detoxification?

  • “Next Mission Living is not a detoxification or medical treatment facility. Please seek appropriate medical or treatment support. You may still submit this application for future consideration after stabilization.”

    Flag the application as “Medical or Detox Referral Needed.”

    Do not automatically reject someone solely because they disclose a history of substance use. Flag recent use, withdrawal, unwillingness to follow substance-free policies, or inability to live safely for individual review.

  • INDEPENDENT LIVING ABILITY

  • Rows
  • 1. Do you use a wheelchair, walker, cane, prosthetic device, oxygen, or another mobility or medical device?
  • 2. Do you require a caregiver, home health aide, attendant, nurse, or other person to assist you?
  • 3. Can you safely be left alone in the home?
  • 4. Can you understand and follow written and verbal house rules?
  • 5. Can you safely evacuate the home during an emergency?
  • 6. Do you need an accessible bedroom, bathroom, entrance, or other reasonable accommodation?

  • HEALTH AND WELLNESS

  • Privacy notice

    This is a preliminary housing suitability inquiry and not a medical examination.

  • Which of the following do you currently use? (Check all that apply)

  • Applicant may select “Prefer to discuss privately.”

    Do not ask for a full diagnosis list on the initial public application. Ask only about functional needs, safety, and reasonable accommodations.

  • SAFETY AND LEGAL SCREENING

  • Answers do not automatically result in denial and will be reviewed in accordance with applicable law and program safety requirements.

  • 1. Are you currently on probation, parole, or supervised release?
  • Format: (000) 000-0000.
  • 2. Do you have pending criminal charges?
  • 3. Have you been convicted of an offense involving physical violence, threats, arson, sexual misconduct, or serious property damage?
  • date
     - -
  • 4. Are you subject to any current restraining order, protective order, no-contact order, or residency restriction?
  • 5. Have you ever been removed from housing because of violence, threats, weapons, serious property damage, or conduct that endangered others?
  • 6. Do you possess a firearm or weapon?

  • Whether the applicant is willing to comply with all property and program weapons policies.

    Do not automatically score or reject applicants based solely on arrest history or broad criminal-history questions. Flag responses for individualized review.

  • TRANSPORTATION AND DAILY ROUTINE

  • Do you have a valid driver’s license?
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  • If you are unable to upload your identification today, you may provide it before move-in.

  • How do you normally travel?

  • GOALS AND PROGRAM FIT

  • 1. What are your primary goals while living at Next Mission Living?

  • REFERRAL INFORMATION

  • 1. How did you hear about Next Mission Living?
  • 2. Are you being referred by an organization or professional?
  • Format: (000) 000-0000.
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  • EMERGENCY CONTACT

  • Format: (000) 000-0000.
  • Can this person make decisions in an emergency?
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  • How did you hear about us?

  • PROGRAM ACKNOWLEDGMENTS

  • SIGNATURE

  • Date
     - -
  • Should be Empty: