HOUSING APPLICATION

Please complete the application below. All applications are reviewed prior to approval. Submission does not guarantee placement or availability.

Applicant:

I acknowledge that I have been advised to proceed to the application stage of the Kasaco placement process. I understand that by submitting this application does not guarantee housing placement.

I acknowledge and wish to proceed.

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Address

I understand that Kasaco offers shared living accommodations and room assignments are based on availability.

Please Note: Kasaco offers shared living accommodations. Private room options are not available at this time.

Emergency Contact (Name & Number):

CURRENT LIVING SITUATION:

How Long Have You Been in This Living Situation?

Select:

HEALTH

Do you require any accommodations related physical, mental or medical conditions?

Yes

No

Communicable Disease safety

For the safety of all members in shared living spaces, please confirm the following:

I do not currently have any communicable condition that may pose a health risk in shared housing.

I am currently receiving treatment for a communicable condition but have been medically cleared for shared housing.

Prefer not to disclose.

LEGAL HISTORY

To ensure safety within shared housing, please answer the following. Disclosure does not automatically disqualify an applicant. Each application is reviewed individually for program compatibility and safety.

Have you ever been convicted of a criminal offense in the past 7 years?

No

Yes

Do you have any pending charges?

No

Yes

Are you currently on?

Probation

Parole

Pretrial supervision

No

Are there any current legal matters that may affect your residency (court dates, supervision requirements, etc)?

No

Yes

MOVE-IN

Preferred Move-In Timeline:

Immediately

Within 30 days

30–60 days

Unsure

Length of Stay You’re Seeking

1–3 months

3–6 months

6+ months

INCOME

Monthly Income

Under $1,500

$1,500–$2,500

$2,500–$3,500

$3,500+

COMMUNITY FIT

Why are you interested in living at Kasaco?

Have you lived in shared housing before?

No

Yes

Have you ever been asked to leave shared housing, a program, or a residence due to rule violations?

No

Yes

Are you comfortable following shared house rules?

No

Yes

Do you smoke?

No

Yes

Do you have any pets?

No

Yes

Is there anything else you’d like us to know?

How did you hear about us?

Acknowledgments:

I understand Kasaco is a shared living environment.

I understand approval is required prior to move-in.

I understand submission does not guarantee placement.

I consent to a background check if required as part of the review process.