Housing Intake Form

Where Stability Meets Compassion.

Thank you for your interest in Community Care Homes. Please complete this online intake form so we can learn more about your housing needs and determine whether our program may be a potential fit.

Community Care Homes provides safe, stable, structured shared housing for adults who are able to live independently in a shared-housing environment.

Submission of this form does not guarantee housing, placement, or acceptance. Housing is subject to availability and program requirements.

1. Applicant Information

Full Legal Name *

Preferred Name

Date of Birth *

Phone Number *

Email Address *

Current City *

Preferred Contact Method

PhoneTextEmail

Best Time to Contact You

MorningAfternoonEvening

6. Background & Safety

Have you ever been convicted of a criminal offense?

YesNo

If yes, please briefly explain

Do you currently have any pending criminal charges or legal matters?

YesNo

If yes, please explain

Are you currently required to register as a sex offender?

YesNo

Are there any probation, parole, court, or other legal restrictions that may affect your ability to live in shared housing?

YesNo

If yes, please explain

9. Housing Goals

What is the main reason you are seeking housing?

What are you looking for in a new home?

What would help you maintain stable housing?

Is there anything else Community Care Homes should know about your housing needs or support needs?

10. Background Check — $35.00

Community Care Homes conducts a background check as part of its safety screening process for individuals seeking placement.

Background Check Fee: $35.00

The $35.00 background check fee is collected for the cost of the background screening and is intended for safety and screening purposes.

Once your application is approved, a link to submit your background check through Innago will be emailed to you.

Please acknowledge the following:

I authorize Community Care Homes to conduct a background check for safety and screening purposes.I understand that the $35.00 background check fee is for the background screening process and does not guarantee housing or placement.I understand that a background check result does not, by itself, determine whether I will be accepted or denied placement.I understand that Community Care Homes may consider background information together with program requirements, housing availability, safety considerations, and my ability to live independently in a shared-housing environment.

11. What Happens After Approval?

If you are approved to move forward with Community Care Homes, you will receive a secure link by text message through Innago to complete the required electronic onboarding.

Through Innago, you will electronically complete:

Background check
Community Care Homes Program Participant Agreement
Required onboarding documents
Electronic acknowledgments and signatures

Everything is electronic

You must have a valid email address, a working mobile phone number capable of receiving text messages, and internet access to complete the electronic documents.

Your Innago link will be sent by text message or email, whichever you prefer, after you are approved to move forward. Please make sure the phone number and email address provided on this form are accurate and accessible to you.

12. Program Participant Agreement

If approved, you will receive the Community Care Homes Program Participant Agreement through Innago.

You must review and electronically sign the agreement before move-in.

The electronic agreement may include program rules, participant responsibilities, payment information, household expectations, and other required onboarding documents.

I understand that required onboarding documents must be completed electronically through Innago before move-in.

13. Final Acknowledgment

I certify that the information I provided on this intake form is true and accurate to the best of my knowledge.I understand that submitting this form does not guarantee housing, placement, or acceptance into Community Care Homes.I understand that housing is subject to availability and program requirements.I understand that additional information or documentation may be requested during the screening and onboarding process.

Applicant Full Name *

Electronic Signature *

Date *

Submit Your Housing Intake

After submitting this form, a Community Care Homes representative will review your information and contact you regarding availability and next steps.