• Resident Application/Intake

    Answer only what’s needed to route your placement request and pre-screen benefits and housing needs.

  • Submission & Source

  • Who is completing this form?*

  •  -

  • Applicant Identity & Contact

  • Date of birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  •  -

  • Current Situation & Timing

  • Current living situation*

  • Release, discharge, or move-out date
     - -
    2 digit month, 2 digit day, 4 digit year
  •    
  • Desired move date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Location flexibility*

  • Routing & Track Fit

  • Are you returning to the community after incarceration or detention?*
  • Do you have a disability or health condition but can still live independently?*
  • Are you currently experiencing homelessness or leaving homeless services?*

  • Functional Independence

  • Can you live independently in shared housing without continuous supervision?*
  • Can you safely manage your own medications?*
  • Do you require hands-on personal care from the housing provider?*
  • Do you already have outside personal-care or support services arranged?*
  • Can you follow shared-house expectations such as cleanliness, quiet hours, guest rules, and respectful interaction?*
  • Is there any health, cognitive, behavioral, recovery, mobility, equipment, or safety need that would require specialized staffing, continuous supervision, hands-on care, or otherwise affect safe independent shared housing?*

  • Housing Needs & Accommodations

  • What accommodations do you need?

  • Do you use any medical equipment that needs accommodation?

  • Do you have an animal companion or service animal?

  • Can you follow a no-indoor-smoking or no-indoor-use rule?*

  • Financial Situation

  • Income Sources*

  • Move-In Funds Status*
  • SNAP Status*
  • Representative Payee Involved*

  • Benefits & Income Pre-Screen

  •  -
  • Benefits & Income Pre-Screen Disclaimer
  • Benefits currently received*
  • Benefits pending*
  • Does a health or disability condition currently limit the ability to work?*
  • Approximate accessible savings and other countable financial resources
  • If yes, has the condition lasted or is it expected to last at least 12 months?*
  • Are you a veteran?*
  • If veteran, do you have a VA-rated service-connected condition or believe the condition began or worsened during service?
  • Have you previously applied for SSI, SSDI, or VA benefits?

  • Legal & Background

  • Are you currently under community supervision?*
  •  -
  • Are you currently required by law to register with any state or local agency because of your legal history?
  • Background factors to disclose

  • Consent & Certification

  • Are you willing to share a bedroom with one compatible resident?*
  • Voucher or Subsidy Status*
  • If veteran, discharge type
  • Did you serve at least one day during a recognized wartime period?
  • I authorize Align to contact the resident/applicant regarding this placement request.*
  •  -
  • Should be Empty: