Apply for Housing

Complete the secure application. We’ll review and reach out within 24–48 hours.

Independent Living Facility Client Questionnaire

Please complete the following questionnaire to help us understand your background and needs. This information will remain confidential and will only be used to determine eligibility and the best fit for our community.

First Name

Date of birth

Last Name

Phone *

Email *

Emergency Contact (Name & Phone):

Current Living Situation (e.g., renting, with family, homeless, transitional housing):

How long have you been in your current living situation?

How soon are you needing housing?

Do you currently have a source of income?

If yes, please describe (employment, benefits, pension, etc.):

Monthly Income Amount (approximate):

Do you receive any assistance (government, family, other)?

Any medical conditions or special needs we should be aware of?

Do you have any legal history (optional)?

Why are you interested in joining our independent living facility?

Signature

Clear

Date

Privacy Policy | Terms of Service

Simply Us – The Perfect Living Community

(888) 434-4644 ext 700

[email protected]