Safe Haven Housing Services
Step 1 — Pre-Screen

Resident Pre-Screen Assessment

Please answer the questions below to help our intake team determine whether Safe Haven's Supportive Independent Living Housing is a good fit for your needs. Your responses are sent directly to our intake team and remain private. Fields marked * are required — all others are optional but help us respond thoughtfully.

Applicant Information

Section 1 — Housing Need

Section 2 — Ability to Live Independently

Can you prepare simple meals independently?
Can you bathe, dress, and manage personal hygiene independently?
Can you complete light housekeeping and keep your sleeping area clean?
Can you self-administer your medications without staff assistance?
Can you safely live in a shared room / shared household environment?
Do you require daily personal care, nursing care, or 24-hour supervision?

Section 3 — Physical Support & Transportation

Are you able to evacuate the home independently in an emergency?
Do your physical needs appear manageable in a non-medical shared home?

Section 4 — Mental, Behavioral & Medication Stability

Are you currently taking prescribed medications?
Are you able to take your medications on your own as prescribed?
Have there been any psychiatric hospitalizations, crisis episodes, or emergency interventions in the past 12 months?
Do you feel you can live safely and respectfully with roommates and follow house expectations?

Section 5 — Income & Housing Funding

Is your income or funding source expected to be ongoing and reliable?
Can you provide proof of income or benefits with the application?

Section 6 — Program Participation & Shared Living Fit

Are you willing to follow all house rules and policies?
Are you willing to participate in house meetings?
Are you willing to complete assigned household responsibilities / chores?
Are you willing to respect roommates, staff, visitors, and neighbors?
Are you willing to maintain a clean living space and support a peaceful home environment?
Are you able to comply with a drug-free, violence-free, and harassment-free housing environment?

Additional Notes

Your responses are sent securely to the Safe Haven Housing Services intake team.