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Get Started

Your Next Chapter Can Start Here.

Whether you’re looking for housing for yourself, helping a loved one, or assisting someone through an organization, we’re here to help you learn more about Fee Bloom Living.

Get Started

Your Next Chapter Can Start Here.

Whether you’re looking for housing for yourself, helping a loved one, or assisting someone through an organization, we’re here to help you learn more about Fee Bloom Living.

Looking for Housing?

Complete our housing inquiry or full intake application.

Make a Referral

We welcome referrals from case managers, organizations, and community partners.

Have Questions?

Reach out anytime for more information or to discuss opportunities.

CLIENT INTAKE APPLICATION
REFERRAL FORM

Supportive Housing Client Intake Form

Participant Intake & Enrollment Application

Please complete all sections to the best of your ability. Your information will be kept confidential

  • Date of Intake
  • Referral Agency/ Name of Referrer:
Referral Source (If Applicable)
Situation & Health History
Income Information
Independent Living & Functionality Acknowledgment

Our program is designed for individuals who are high-functioning and capable of living independently. This is not a personal care home, nursing home, or assisted living facility. We do not provide medical care, personal assistance, or supervision.

You must be able to manage your own:
● Personal hygiene and grooming
● Meal preparation and eating
● Medication (unless managed by an outside provider)
● Mobility and transportation arrangements
● Housekeeping and laundry
● Daily living responsibilities
If you require medical or personal care services, they must be provided by a licensed outside agency or caregiver, arranged and paid for separately.
Applicant Declaration

I certify that the above information is true to the best of my knowledge. I understand that this intake does not guarantee placement, and my application will be reviewed by staff.
For Staff Use