Affordable Housing in Detroit | Avalon Meadows Shared Living

2200 Hunt Street #2070 | Detroit, Michigan 48207

Phone: 313-246-3520 | Email: Admin@theavalonmeadows.com

PRE-SCREENING / INTAKE FORM

Thank you! Your intake form has been submitted successfully.

1. Applicant Information

Full Legal Name *

Phone Number *

Date of Birth *

Email Address *

Current Address *

City / State / Zip *

2. Current Living Status

Current Living Situation *

Length of Stay at Current Residence *

Reason for Seeking Housing *

3. Income & Benefits

Primary Source of Income *

Monthly Income Amount ($) *

Do you receive SSI / SSDI / Other Benefits? *

Case Manager (if applicable)

Case Manager Phone

4. Independence Verification

Manage your own medications? *

Yes No

Daily living activities independently? *

Yes No

Require daily supervision? *

Yes No

Receive in-home care services? *

Yes No

If yes, explain:

5. Emergency Contact

Name *

Relationship *

Phone Number *

6. Independent Living Disclosure

Avalon Meadows operates strictly as an Independent Living residence providing housing only.

This property is NOT licensed as an Adult Foster Care facility or Home for the Aged under the Michigan Department of Licensing and Regulatory Affairs (LARA).

No supervision, personal care services, medication management, healthcare services, or assistance with activities of daily living are provided.

Applicant affirms they are capable of independent living and understand that outside services must be arranged independently if needed.

I acknowledge and agree to the Independent Living Disclosure *

7. Legal Notice

Completion of this form does not guarantee approval for residency. All tenancy decisions are subject to screening, verification, and compliance with Michigan landlord-tenant laws including the Michigan Truth in Renting Act (MCL 554.631–554.641) and Fair Housing laws.

Signatures

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Date *

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Management Signature Upload

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Date

Resident Portal

Independent Living Designed with YOU in Mind

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