• Sponsored Residential Applicant Questionnaire

    Share your background, home details, availability, qualifications, and expectations for the role.

  • Applicant Information

  • Home Information

  • Do you own or rent the home?*
  • Do you have a certificate of occupancy? (If you do not, one will be requested on your behalf by Inclusive Living Solutions administration)*
  • If renting, has the landlord verbally approved an individual receiving services living in the home? (A letter will be sent to you for your landlord to sign/approve)
  • Are the bedrooms already furnished?*
  • Are there stairs inside the home?*
  • Are there stairs outside the home?*
  • If there are pets, are updated vaccine records available and is the pet registered with the city of residence?

  • Availability

  • Do you currently work outside the home?*
  • Format: (000) 000-0000.
  • Can you complete 32 hours of unpaid online training plus 8 hours in person in Hampton VA?*
  • Training note: Except for the 8 in-person hours, training is online and self-paced virtual courses, and all quizzes must be passed with 80% or higher.
  • Do you have a valid driver's license?*
  • Do you have reliable transportation?*
  • Are you comfortable driving individuals to appointments, activities, and social events?*
  • Can you provide proof of automobile insurance and updated vehicle registration?*

  • Background and Qualifications

  • Can you pass a criminal background check?*
  • Can every adult living in the home pass a criminal background check?*
  • Have you ever been charged with or convicted of a crime that could affect your ability to work with vulnerable adults or children?*
  • Do you have a current CPR card?*
  • Expires*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you have a current CPI card or other behavior interventions certificate?
  • Do you have a current medication administration certificate?*
  • Renewed Last*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you have the original medication administration certificate, renewal certificate, and skills check sheet?*

  • Lifestyle and Compatibility

  • Comfortable supporting personal care needs (bathing, dressing, meal preparation, or medication administration)*
  • Comfortable supporting behavioral challenges*

  • Financial Stability

  • Are you financially stable without relying on Sponsored Residential income?*
  • Are you comfortable waiting for a suitable match?*

  • Program Expectations

  • Willing to participate in monthly monitoring visits (We do monthly individual book audits & quarterly home inspections)*
  • Willing to maintain daily documentation and complete required paperwork? (Daily accurate documentation is directly tied to payment and continued employment with inclusive living solutions)*
  • Willing to allow unannounced inspections from ILS, OHR, DBHDS, and Medicaid*
  • Should be Empty: