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Resident Intake Form

Take the first step toward your new home. Please provide your basic details below so we can begin your housing journey.

Current Living Situation
Shelter
Treatment Facility
With Family or Friends
Currently Unhoused
Mobility: Are you able to navigate a standard home layout safely
Yes
No
Medication: Are you able to independently take, manage, and safely store your own medications?
Yes
No
Behavioral History: Do you have any history of violence or property damage?
Yes
No
Background Check: Are you currently or ever been registered on any public sex offender registries?
Yes
No

Case Worker Intake Form

Efficient referral process for our community partners. Secure client placement starts here.

Population Group
Room Selection
Shared (starting at $800/month)
Private (starting at $1,300/month)
Does the applicant have the $200 non-refundable community fee?
Yes
No
Source of Income
Does the applicant manage their own money?
Yes
No - Has a Payee
Physical Mobility: Can they navigate a standard home layout safely?
Yes
No
Medication: Can the applicant independently take, manage, and safely store their own medications?
Yes
No
Behavioral History: Any history of violence or property damage?
Yes
No
Background Check: Is the applicant registered on any public sex offender registries?
Yes
No
Did the applicant choose Cozy Pathways?
Yes
No
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