Align Partnership Intake

Partnership Intake

Answer a few questions to route you to the right pathway for referrals, placements, or community partnerships.
Page 1 — Organization & Partnership Path
Organization Name
Primary Contact Full Name

First NameMiddle NameLast Name
Job Title / Role
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Preferred Contact Method
Geographic / Service Area
Website
How does your organization want to partner with Align?
Partner Lead Source
Source Page
Source CTA
Page 2 — Referral Source Pathway
Which Align Senior Independent Living resident pools do you work with?
What reliable income or benefit sources are common among people you may refer?

Other
Approximate referral volume
Is the best referral contact the same as the primary contact above?
Alternate referral contact name

First NameMiddle NameLast Name
Alternate referral contact role
Alternate referral contact phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate referral contact email
example@example.com
Preferred referral/warm-handoff method

Other
Are you open to referring adults who can live independently and accept double-occupancy bedrooms?
Eligibility or referral-process notes
Page 3 — Housing / Placement Provider Pathway
Housing type
Property / facility name
Property / service location

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Room / unit options

Other
Monthly rate or range
Accepted payment sources

Other
Typical availability / update frequency
Independence / care level accepted

Other
Minimum age accepted
Maximum age accepted
Gender accepted

Other
Shared rooms accepted
Private rooms available
Wheelchair accessibility
Mobility aids accepted

Other
Must resident be safe without continuous supervision?
Medication expectation
Hands-on personal care accepted?
Community supervision / probation / parole accepted?
Re-entry / criminal history accepted?
Sex-offender registration accepted?
Nicotine / smoking policy

Other
Service animal / companion animal policy

Other
Substance-free or sobriety requirement
Behavioral or cognitive exclusions
Key accessibility / equipment limitations
Key admission restrictions
Preferred referral method

Other
Typical decision turnaround
Is final admission contact same as primary contact?
Final admission contact name

First NameMiddle NameLast Name
Final admission contact role
Final admission contact phone
Please enter a valid phone number.Format: (000) 000-0000.
Final admission contact email
example@example.com
Page 4 — Community / Resource Partner Pathway
Services / resources offered

Other
Populations served

Other
Service area
Basic eligibility
Preferred referral method

Other
Is best resource contact same as primary contact?
Alternate contact name

First NameMiddle NameLast Name
Alternate contact role
Alternate contact phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate contact email
example@example.com
Page 5 — Authorization
Acknowledgment
Typed Name Confirmation

First NameLast Name
Should be Empty:

Partnership Intake

Page 1 — Organization & Partnership Path

Page 2 — Referral Source Pathway

Page 3 — Housing / Placement Provider Pathway

Page 4 — Community / Resource Partner Pathway

Page 5 — Authorization