Independent Living Application

The Welcoming Winston is an independent living program for adults sharing one home. Before you begin, please have the following ready: a form of ID (such as a driver’s license or passport), Social Security number or ITIN, residence information, employment history, and proof of income or benefits.

Section 1

Eligibility Criteria

Please review carefully. This program is intended for adults 18 and older. Residents must be able to live independently and follow the community guidelines.

Are you a U.S. citizen, permanent resident, or eligible non-citizen? *

Yes, U.S. citizen Permanent resident Eligible non-citizen None of the above

Section 2

Your Personal Information

Full name as it appears on your ID *

Write N/A if you don't have a middle name.

Social Security Number or ITIN *

Date of birth *

Select Month, Day, and Year easily from the dropdown menus.

Email *

Phone number *

Do you understand that if you do not submit a picture of your valid ID or driver's license your application cannot and will not be processed? *

Yes No

Picture of government-issued ID or Passport *

Click anywhere here to select your ID photo or document

Drag and drop file here, or click to browse

Accepted formats: JPG, PNG, or PDF (Max 10MB)

Preferred move-in date *

Intended duration of stay *

Section 3

Residence History

Section 4

Employment History

This information helps us verify current employment, financial stability, financial responsibility, and average income.

Are you currently employed? *

Yes, I have an employer Yes, I am self-employed No, I am unemployed

Current employer

Position / Title

Monthly gross income

Section 5

Economic Resources

Are you currently receiving Social Security? *

Yes No

Section 6

Occupancy

Just me Applying with a partner or family member who will share the room

Signature & Attestation

Attestation: I confirm that everything I've completed above is truthful, honest, and accurate.

Full Legal Name *

Digital Signature (Draw with hand / mouse / stylus) *

Sign your name here using your mouse or finger