Apply Now – Room to Rest

sharedliving@roomtorest.org
404-487-8681

(336) 443-8878

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Menu

Home
About us
Services
Who We Serve
Amenities
Referrals
Locations
FAQs
Contact us
Apply Now

Apply Now

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Apply Now

Housing Questionaire Form

Start your journey to shared community housing program. Fill out this quick 3-step form and our coordinator will contact you within 24–48 hours.

Full name

Date of Birth

Phone Number

Email Address (If Available)

Current Address

Where were you referred from?

Do you have a steady source of income?

Yes No

What is your main source of income?

SSI SSDI Employment VA Benefits Other

If Other, Write Here

What is your estimated monthly income?

Do you receive Food Stamps / EBT (SNAP benefits)?

Yes No

Do you have a working phone we can use to contact you?

Yes No

Are you able to live independently without daily assistance?

Yes No

Do you currently receive help with daily activities (cleaning, cooking, hygiene, etc.)?

Yes No

If Yes, Please Explain

Are you currently taking any prescribed medications?

Yes No

Do you have any difficulty accessing your medications (cost, transportation, insurance, etc.)?

Yes No

If Yes, Please Explain

What type of room are you looking for?

Shared Room Private Room Private Room with Bathroom No Preference

When do you need housing? (Move-in date)

Do you have any physical disabilities or mobility concerns?

Yes No

If Yes, Please Explain

Have you ever been evicted from a previous residence?

Yes No

Have you ever been convicted of a felony?

Yes No

Are you a registered sex offender?

Yes No

Are you willing to follow house rules (e.g., no drugs, no unapproved guests, quiet hours, cleanliness)?

Yes No

Do you smoke?

Yes No

Do you have any pets?

Yes No

Why are you seeking housing at this time?

Is there anything else you'd like us to know?

Get Started

Ready for a Safe Place to Rest?

Room to Rest offers safe, affordable shared community housing with shared sleeping spaces for independent adults (18+). If you’re seeking stability, structure, and a supportive living environment, start your application today.

Room to Rest is a shared community housing program providing safe, affordable shared housing with shared sleeping spaces for independent adults (18+). Residents live in furnished shared rooms and share common living areas within a structured, supportive environment that promotes stability, dignity, and community.

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Our Services

Shared Independent & Transitional Housing
Veteran & Senior Housing Support
Coordinated Referrals & Housing Placement
Supportive Community Living

contact information

404-487-8681
sharedliving@roomtorest.org

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