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Shared Haven Independent Living

Resident Application

Thank you for your interest in Shared Haven Independent Living. Please complete this application in its entirety. Submission does not guarantee acceptance. All information provided will be kept confidential and used solely to determine eligibility for residency.

Applicant Information

Length of Time at Current Address

Emergency Contact

Eligibility

Please check all that apply

Employment Information

Housing Needs

Bedroom Preference
Expected Length of Stay

Rental History

Have you ever been evicted?
Have you ever broken a lease?
Do you currently owe money to a landlord?

Background Information

Have you ever been convicted of a violent felony?
Are you currently on probation or parole?
Are you required to register as a sex offender?

Health & Wellness

Do you require any reasonable accommodations?
Do you have any medical conditions that staff should be aware of in case of an emergency?

House Rules Acknowledgement

I understand that if accepted into Shared Haven Independent Living, I will be expected to follow all house rules, including but not limited to:

  • Keeping my room and common areas clean
  • Paying rent on time
  • Respecting fellow residents
  • Maintaining a drug-free environment
  • No violence or threatening behavior
  • No unauthorized overnight guests
  • Observing quiet hours
  • Following all Shared Haven policies

References

Reference #1

Reference #2

Applicant Certification

I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading information may result in denial of my application or termination of residency if discovered after acceptance. I understand that submission of this application does not guarantee housing.

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