Fill out some info and we will be in touch! Name * First Name Last Name Email * Phone * (###) ### #### Gender * Male Female Other Birthday * MM DD YYYY How did you hear about us? * Are You a Smoker? * Yes No Do you have a job? * Yes No Briefly describe why you would like to be considered for Aunty Minnie's House? * Do you own a vehicle? * Yes No Are you able to care for yourself without any assistance (walk, bathe, cook, get dressed)? * Yes No Do you have any felonies / convictions? If yes, please explain below. * Yes No What is your monthly income? * Realistically, how much are you able to afford for housing and utilities on a monthly basis? * Do you receive any type of assistance from the government? If so, what kind? (Medicaid, Medicare, food stamps, etc.) * Do you understand, this is a shared living environment and you will share a room with another person? * Yes No Do you understand that one monthly payment will cover your rent , utilities, wifi, monthly house cleaning, quarterly pest control? * Yes No Do you understand that you are responsible for your own food, transportation, medical appointments, etc? * Yes No Do you understand that Aunty Minnie's House is ONLY providing a furnished, safe residence? We are NOT a group home that provides services. * Yes No If there is anything you would like Aunty Minnie's House to know in considering your application, please do so now. Your application has been submitted. Some one will be in touch with you soon!
