Resident Assessment

Help us understand your housing needs, goals, and shared-living preferences.

Applicant Information

Full namePreferred name PhoneEmail Preferred move-in date

Current Housing

Current housing Primary reason for seeking housing

Housing Needs & Goals

Select what you are looking for Stable housing Safe environment Community support Help connecting with resources Independent-living support

What would help you feel safe and comfortable in your new home?

Independent Living

Areas where you may benefit from support Maintaining a clean living space Laundry Meal planning/preparation Transportation planning Budgeting Employment/job resources Community resources

Shared Living

Comfortable living with other adults? Willing to follow house rules and community expectations? How do you typically handle disagreements or conflicts?

Safety & Accommodations

Anything that could affect safe participation in shared living? Accessibility or accommodation needs you would like to discuss?

Emergency Contact

NameRelationshipPhone

Safety, Awareness & Independent Living

Does the applicant demonstrate awareness of their surroundings and basic safety needs? In an emergency, can the applicant independently recognize the need to evacuate and exit the residence without physical assistance? If assistance is needed during an emergency, please describe: Can the applicant independently manage and take their medications as prescribed? If assistance or reminders are needed, please describe: Does the applicant currently have a source of income?

If yes, what type of income? Employment Social Security / SSI / SSDI Veterans benefits Pension / retirement Public assistance Other

Approximate monthly income: $ Is there anything about the applicant's ability to safely live independently or participate in shared living that Thrive Residential should be aware of?

For Thrive Residential Staff Only

Assessment completed by: Assessment date: Emergency evacuation support notes: Medication self-management notes: Accommodations or support considerations: Staff follow-up needed?

Resident Goals

Goals for the next 3–6 months What would successful housing look like for you? I understand that completing this assessment does not guarantee housing or placement with Thrive Residential. I understand that shared living requires residents to follow applicable house rules and respect other residents and the property.

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