Interested in becoming a resident?

If you or someone you love is interested in the program, let us know! Before scheduling a visit to the program, please fill out our Level of Independence (LOI) Assessment. 

LEVEL OF INDEPENDENCE (LOI) ASSESSMENT 

This form is ALL ABOUT YOU! It helps us get to know you and to see how we can help you live independently. Answer the following questions by selecting the answer that BEST describes you. BE HONEST! There is no right or wrong answer. If you need to include any extra info about the following questions, there is a place to write at the end.

Name of Potential Resident *
Name of Potential Resident
Name of Person Helping or Filling Out Form *
Name of Person Helping or Filling Out Form
Date *
Date
This section can be as long as necessary.
Who should we call to discuss your interest in the program?
Who should we call to discuss your interest in the program?
Phone Number
Phone Number