Apply Now for ICS Apartments

Requirements :
Must be on one of the waiver services (CADI, BI, CAC, DD)
Must have an active SSI or SSDI
GA (General Assistance/MSA)
Must be 18years and Older.

Applicant Information

Gender:

Source of Income (Employment if Employed). All Income must be verifiable.

Rental History within the last two years. (Starting with most current).

Address

City, State

Rent Paid

Other Information:

Eviction
Felony
Other Criminal Records

If yes, please explain: (*Calvalry will do a Background check on all applicants).

Does this person have: (mark if known; leave blank if unknown)

Mental Health Case Manager?
(If yes, enter information below)
Waiver Case Manager?
(If yes, enter information below)
Waiver Type
Care Coordinator with primary clinic or insurance company?

Mental Health Case Manager Information

Would you like to be updated on all assessment scheduling & treatment of services?

Waiver Case Manager Information

Would you like to be updated on all assessment scheduling & treatment of services?

Care Coordinator Information

Would you like to be updated on all assessment scheduling & treatment of services?

Legal Status & Legal Representative Contact Information

Primary Emergency Contact Information

Case Manager/ Other Provider Type Contact Information/ Referral Source

Would you like to be updated on all assessment scheduling & treatment of services?