Inclusive Housing Interest Form 2024

HOPE NC is a 501c3 non-profit organization working to expand inclusive housing options for older adults and adults with intellectual or developmental disabilities in NC. Our goal is to build housing from the ground up as a pilot project within the next 4-5 years in the Triangle. In the interim we are working with partners to find ways to increase inclusive housing options in the next year or two. For example, we may secure units in a development that is already being planned or is under construction and then provide an onsite Community Facilitator for that development to support all residents. Any additional supports needed by the individual will be the responsibility of the resident and/or family. We are looking at both rental and home ownership options.

This form is designed to collect data about people interested in moving into inclusive housing in the Triangle - This form does not place someone on a wait list for housing. It is designed to help us gather information about the potential future resident and the type of housing and location that is desired.

Once completed, we will use this information for a few purposes. For one, we can update and maintain accurate records with respect to interest in housing opportunities in our area, which can be helpful in our advocacy work around the creation of more inclusive housing. Second, we occasionally reach out to individuals and families to inform them of programs and services in the community that might be useful. These include self-advocacy events and programs and notices from community partners about beneficial programs related to disability and aging. Third, when we send out updates about HOPE NC and the housing projects we are starting, you will be included in those updates

Please note: All survey form responses are confidential and will not be shared outside of HOPE NC without your permission.  Completing this survey DOES NOT place someone on a wait list for housing

Sign in to Google to save your progress. Learn more
Email *
Your Name
*
Name of Individual Needing Housing
*
Year of Birth of Individual Needing Housing
*
How soon will the individual need housing?
*
Please check all of the areas you would consider for housing
*
Required
Would the individual want to live alone or with a roommate?
*
If with a roommate, do you have someone identified?
*
Please check which options might be possible for you:
*
Required
Does the individual needing housing have a Medicaid Waiver
*
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of HOPE North Carolina Inc. Report Abuse