WaitList Application

For persons 55 years of age or older and able to live independently.

*Proof of Age required with Application. Email a copy of your ID to beth@claremeadows.com or you may upload it from your Google Drive (if applicable) See the last section below.

Person 1 Name

First Name

Last Name

Address: Street

Address: City, State, Zip Code

Phone Number

Country

(###)

###

####

Email

Date of Birth

MM

DD

YYYY

Qualify for Income-Eligible? 1-person income under $42,300; 2-person income under $48,300

If yes, complete INCOME ELIGIBLE WORKSHEET FORM

Yes

No

Person 2 Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Total Gross Income For Household

$

Alternate Contact Information

How many bedrooms would you like?

1

2

Either

Pets?

Yes

No

Type(Pets)

How Many Pets?

Do you Smoke?

Yes

No

Desired date of move-in?

MM

DD

YYYY

How did you hear about Clare Meadows?

Upload File

http://

We encourage and support the nation's affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status.