ZOOM
Print

Javascript is required! Please turn it on to complete this form.

What would you like to apply for?

Applicant *

Email *

Phone *

Phone Type


Phone

Phone Type


Phone

Phone Type


Residential Address *

Mailing Address *


Questions

Are you or anyone else in your household 60 or older? *

Are you a care provider of someone 60 or older? *

How many people live in your home? *

Household Member *

Gender *

Relationship to Applicant *


* Our staff may need to contact you regarding this information when processing your application

Is this household member a US Citizen? *

Is this household member a veteran of the US Armed Forces?

Ethnicity

Race

Does this household member have a disability? *

Is this a developmental disability? * i

Select all non-cash benefits that this household member receives:

Does this household member have health insurance?

Select all income sources this household member currently receives or has received in the last 3 months: *

What best describes this household member’s employment status? *

How much do you make a month? *

Seeking Employment

How stable is this household member’s housing situation?

What is this household member’s highest completed level of education?

Is this household member currently in school? *

Does this household member have a checking or savings account? *

Does this household member pay for childcare?

Household Member *

Gender *

Relationship to Applicant *


* Our staff may need to contact you regarding this information when processing your application


Is this household member a US Citizen? *

Is this household member a veteran of the US Armed Forces?

Ethnicity

Race

Does this household member have a disability? *

Is this a developmental disability? * i

Select all non-cash benefits that this household member receives:

Does this household member have health insurance?

Select all income sources this household member currently receives or has received in the last 3 months: *

What best describes this household member’s employment status? *

How much do you make a month? *

Seeking Employment

How stable is this household member’s housing situation?

What is this household member’s highest completed level of education?

Is this household member currently in school?

Does this household member have a checking or savings account?

Does this household member pay for childcare?

Please select which apartments you are interested in: *

View Apartments here:
Hillcrest | Fairview Terrace | Six Pines | Clearwater Terrace | Ponderosa Court | Clarkston Rancher Duplex

Please select your current housing type: *

i i i i i i 

Please select your household’s occupancy status: *

How much is your household’s total rent? Do not include space rent. *

Is your household’s rent subsidized? *

Are your household’s heating costs included in your rent? *i

When was your home built?

Please estimate the square footage of your home.

Please enter your landlord’s contact information. *

Which fuels does your household use to heat your home?

Please indicate all energy sources that you use to heat your household: *


Heating System Type *

Status: *



Status: *



Status: *



Status: *



Status: *



Status: *



Status: *



Status: *



Status: *



Please enter the following information about your electricity provider: *

Please complete the following information about your water heater:

Water Heater Type *

Water Heater Status *

Please complete the following information about your air conditioner:

Air Conditioner Type *

Air Conditioner Status *