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Safe Independent Transitional Residential Living

Housing Pre-Screening Application

Thank you for your interest in Safe Independent Transitional Residential Living.

We provide affordable transitional housing for independent adults in a safe, structured shared living environment throughout the Sacramento area.

Please complete the pre-screening form below. Completing this form does not guarantee housing or placement. Applications will be reviewed based on availability and program eligibility.

Person Completing This Form

Who is submitting this form?

Self Family Member or Friend Case Manager / Social Worker / Agency Representative

If someone other than the applicant is completing this form:

Name

Agency (if applicable)

Relationship to Applicant

Phone Number

Housing Interest

Which housing are you interested in?

Men’s Housing Women’s Housing

Applicant Information

Applicant Full Name

Phone Number

Email Address

Preferred Method of Contact

Call Text Either Call or Text

Housing Preferences

Preferred Room Type

Shared Room ($800–$950/month) Private Room ($1,000–$1,200/month, if available)

Desired Move-In Timeframe

Immediately Within 30 Days Within 60 Days Flexible

Preferred Days and Times for an In-Person Tour

Current Housing Situation

Income Information

Monthly Income Amount

Support Services

Are you currently working with any of the following?

If yes, please provide their name and agency

Additional Screening Questions

Do you currently have any pets or service animals?

No Yes

If yes, please explain

Program Expectations

Please acknowledge each statement below before submitting your application.

I understand this is shared transitional housing. I understand that Safe Independent Transitional Residential Living serves independent adults. I understand that all residents are expected to follow house rules and respect fellow residents. I understand that a background screening may be required before move-in. I understand that completing this form does not guarantee housing. I understand that rent, deposits, and program requirements will be discussed during the intake process.

Additional Information

Is there anything else you would like our team to know?

Additional Information

By submitting this form, I certify that the information provided is true and accurate to the best of my knowledge. I understand that providing false or misleading information may affect my eligibility for housing.

Applicant Name

Date

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Safe Independent Transitional Residential Living

Housing Pre-Screening Application

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