Are you able to live independently without daily assistance?*

Do you currently receive help with daily activities? (Cleaning. cooking, hygiene, etc.)*

Are you taking any prescribed medication?*

Do you have a steady source of income?*

Do you receive Food Stamps / EBT (SNAP benefits)?*

Do you have a working phone we can use to contact you? *

Are you able to live independently without daily assistance?*

Do you have any difficulty accessing your medications (cost, transportation, insurance, etc.)?*

What type of room are you looking for?*

Do you have any physical disabilities or mobility concerns?*

Have you ever been convicted of a felony?*

Are you a registered sex offender? *

Are you willing to follow house rules (e.g., no drugs, no unapproved guests, quiet hours, cleanliness)?*

Do you smoke?*

Do you have any pets?*