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Are you 60+ years of age?
Are you independent with all of your Activities of Daily Living (ADLs)?
ADLs include: Bathing, Dressing, Grooming, Toileting, and Mobility.
Are you willing to share space with other responsible seniors (bedrooms, bathrooms, common living areas)?
Do you use an assistive device for walking? (Select all that apply)
Are you able to go up and down 3 steps with a handrail?
How often do you require a wheelchair for mobility?
Do you receive guaranteed income?
Soc. Security, SSI, SSDI, VA, Pension, or Other
Monthly Income
Resident Name
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