Housing Intake Application
Bridging the Gap to Build a Better Future. Thank you for your interest in our safe and affordable independent shared housing services. We provide welcoming, community-based housing opportunities for adults ages 55 and older, including seniors, veterans, and individuals receiving SSI, SSDI, or veteran benefits. Whether you are seeking housing for yourself, assisting a loved one, or submitting a referral on behalf of a client, we are here to help. Please complete the application below so our team can review your housing needs and contact you regarding availability and next steps. Serving Baltimore, Maryland and Washington, DC communities.
Client Full Name
*
First Name
Last Name
Client Email Address
*
example@example.com
Client Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is the applicant 55 years of age or older?
*
Yes
No
Client Type
Please Select
Veteran
Senior
Hospital Discharge
Other
Who is completing this housing application?
Please Select
I am applying for myself
I am submitting on behalf of someone else
Referral Partner Information
Referral Partner Full Name
First Name
Last Name
Organization / Agency Name
Relationship to Applicant
Please Select
Social Worker
Case Manager
Hospital Discharge Planner
VA / Veterans Organization
Family Member
Church / Community Organization
Other
Referral Partner Email Address
example@example.com
Referral Partner Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is the applicant's source of income
*
Please Select
SSI
SSDI
Veteran Benefits
Other
Which location are you applying for?
Please Select
Waldorf, MD
Washington, DC
Preferred room type
*
Please Select
Shared
Private
Desired move-in date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Authorization & Consent
I certify that the information provided in this application is accurate to the best of my knowledge. If I am submitting this application on behalf of another individual, I confirm that I have permission from the applicant or their authorized representative to share this information with NOLB Real Solutions LLC. I authorize NOLB Real Solutions LLC to contact the applicant or designated referral partner regarding housing availability and next steps. I understand that submitting this application does not guarantee housing availability or placement.
Authorization Acknowledgment
*
I have read and agree to the Authorization & Consent statement above.
Submit Housing Application
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