Solon Community Living Statement of Interest Form

The Statement of Interest form will take approximately 15 minutes to complete.

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* 1. Date Completing the Form

Today's Date

Date

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* 2. First Name of Who is Completing the Form

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* 3. Last Name of Who is Completing the Form

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* 4. Who is completing the form?

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

County *

Email Address *

Phone Number *

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* 5. Potential Resident First Name

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* 6. Potential Resident Last Name

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* 7. Potential Resident Information

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

County *

Email Address *

Phone Number *

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* 8. Potential Resident's date of birth (must be at least 23 years old at the time of move-in)

Date of Birth:

Date

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* 9. What is the potential resident's gender?

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* 10. Does the potential resident have a legal guardian?

Yes

No

Unsure

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* 11. Does the potential resident have people (other than their parents) that support them in their life?

Yes

No

Unsure