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Housing Operator Intake Questionnaire

Silver Lining Solutions

Program Name/ Business *

First Name *

Last Name

Phone *

Email *

Organization Type *

Share Housing for Independent Adults

Assisted Living

Property Information

Property Address

Type of Housing Offered

Shared rooms only

Private rooms only

Shared rooms with Private Rooms

Number of Rooms

Number of Beds per Shared Room

Number of Beds per Private Room

Do you have car parking space?

Yes

No

Do you allow pets inside the house?

Yes

No

Yes, only in private rooms and 1 small pet is allowed

No, but we have a space in the backyard where their pets can stay

Please put your area code and nearby zip code where tenant might consider

Resident Fit and Requirements. Select all that apply

Who is this housing best suited for? Select all that apply

Eligibility Requirements. Select all that apply

Background checkIncome verificationProgram referral requiredSobriety requirementsCurfewHouse meetingsOther house rulesCheckbox 18lqv

Are there restrictions you need us to know about?

Support and Structure

Is this housing supportive or independent?

Supportive

Semi-structured

Independent

What supports are available on-site or connected to the housing? Select all that apply

Financial Details

Monthly Rent for Shared Rooms per bed

Monthly Rent per Private Rooms

Deposit Required

Yes

No

Availability and Process

How quickly can a placement usually happen?

What does your intake process look like?

(Example: referral, interview, background check, move-in timeline.)

By checking this box, I consent to receive non-marketing text messages from Silver Lining Solutions about Housing Referral Service. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others.from Silver Lining Solutions at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

We want to be clear about how our referral process works. When each placement is successful, Silver Lining Solutions charges a $300 referral fee. A placement is considered successful once the resident has moved in. Payment is collected 3 days after move-in. This fee helps cover coordination, screening, and communication during placement. *

I understand and acknowledge the referral fee structure

I prefer not to proceed

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