Milestone Senior Living

Make Milestone Moments Throughout the Seasons!

Application for Residence

Our company recognizes that this information is confidential and privileged in nature and will be used for application processing purposes only. An application needs to be filled out on each applicant.

DESIRED LOCATION:




APPLICANT:

MARITAL STATUS:

SPOUSE (If Applicable):

CURRENT ADDRESS AND TELEPHONE NUMBERS:

PREVIOUS ADDRESS:


TIME FRAME FOR NEEDING RESIDENCE:



STYLE OF APARTMENT DESIRED:



WILL YOU NEED PARKING ACCOMMODATIONS?

HOW DID YOU HEAR ABOUT MILESTONE?

HAVE YOU BEEN CONVICTED OF AN ASSULTIVE CRIME?

(A criminal record is not an automatic bar from admission and will be considered only as it relates to the safety/security and risk to other tenants and residents).

EMERGENCY CONTACT INFORMATION:

EMERGENCY CONTACT #1

EMERGENCY CONTACT #2



If this document has been prepared by a person other than the applicant(s), please indicate Name, Address, and Phone Number below:

How do you wish to be contacted?