• HOUSING INTAKE/QUALIFICATION FORM

    KP LIVING SOLUTIONS LLC

  • Participant Eligibility Screening


    This Qualification Form is used to determine whether an applicant meets the basic eligibility requirements for residency within KP Living Solutions LLC.

    Completion of this form does not guarantee acceptance into the Housing Program. Admission is subject to eligibility requirements, available space, and successful screening. 

    KP Living Solutions LLC is committed to providing equal housing opportunities. We do not discriminate on the basis of race, color, religion, sex, national origin, disability, familial status, age, or any other characteristic protected by applicable federal, state, or local law. All applications are reviewed using the same eligibility standards and screening criteria.

  • APPLICANT INFORMATION

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Are you a Senior (55+)?*
  • Race*
  • Gender*
  • Are you a Veteran?*
  • Is the applicant currently on Probation/Parole?*
  • Is the applicant an ex-offender?*
  • Has the applicant been convicted as a Sex Offender?*
  • Format: (000) 000-0000.
  • I give permission to leave a message/text both applicant and reprentative/sponsor.*

  • BASIC ELIGIBILITY

  • Are you at least 18 years of age?*
  • Do you have a valid government issued photo ID?*
  • How will applicant pay monthly fee?*
  • Can you provide proof of income or financial support?*

  • HOUSING NEED

  • What best describes your current housing situation?*
  • When does the applicant need to be placed?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you require any reasonable accommodations for a disability?*

  • SHARED HOUSING COMPATIBILITY

  • This Housing Program operates within a shared living environment that may include shared bedrooms and common living spaces.

  • Are you willing to share a bedroom with another person?*
  • Are you willing to follow house rules and community standards?*
  • Can you live respectfully with others in a shared environment?*
  • Are you willing to participate in maintaining a clean and safe living environment?*

  • SUBSTANCE-FREE HOUSING REQUIREMENTS

  • KP Living Solutions LLC operates a substance-free housing environment.

  • Do you agree to comply with the Substance-Free housing policy?*
  • Do you understand that illegal drug use, possession, distribution, violence, threats, and prohibited weapons are grounds for corrective action and termination?*

  • SAFETY SCREENING

  • Have you ever been removed from a housing program, transitional housing, sober living home, shleter, or similar housing environment?*
  • Do you currently have any conditions that may prevent you from safely participating in a shared housing environment?*

  • APPLICANT CERIFICATION

  • I certify that the information provided on this Qualification Form is true and accurate to the best of my knowledge.

    I understand that providing false or misleading information may result in denial of admission or termination from the Housing Program if discovered after admission.

    I understand that completion of this form does not guarantee acceptance into Pathway to Hope Foundations.

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  • Todays Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: