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Application For Individual Independent Shared Living Residents

Dear Applicant,


Currently, we are only processing housing applications for unaccompanied individuals (singles).  Regrettably, we will be unable to facilitate housing arrangements for couples, pets, or families with children at this time. Please understand that our current housing options are designed for Independent Shared Living homes only. We appreciate your interest and hope you will consider
our programs.


All personal identifying information (PII) will be considered private and confidential and will not be shared with any external agencies or for any purpose without their explicit consent other than to secure housing for the applicant named below.

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Gender

The following qualifying questions are designed to verify your ability to live an Independent Shared Living lifestyle in one of our designated residences. Please affirm that you are able to do each of the following by initialing next to the activity. If the answer would be no, please leave blank.

Multi choice

Buffalo Harbor House, LLC only requires one (1) source of income as long as that income source will cover your housing costs. For SSI residents we recommend that their housing costs do not exceed 1/2 of their total monthly net income.


Personal Individual Retirement Accounts may also be included as a funding source. No individual should ever sign away the full value of their retirement account/plan in order to qualify for or receive housing. Retirement accounts should be set up to pay out a monthly draw or a regular dividend/yield, this is the amount you should include as part of your Monthly Net Income below. Financial coaching can be provided to residents entering the Buffalo Harbor House community for the first time, and at no cost, to ensure that you are getting the most out of your

money and are able to retain ownership of your funds for as long as possible.

What is your Estimated Monthly Income after taxes (take home pay):

Please add the contact details for any agency personnel, case managers, or social workers you regularly work with regarding these subsidies:

Contact 1

Contact 2

Contact 3

Please answer the following completely and honestly in order to ensure that any housing selections are compliant with state and federal regulations. Buffalo Harbor House, LLC is absolutely committed to your personal privacy. All personal identifying information (PII) will be considered private and confidential and will not be shared with any external agencies or for any purpose other than to secure housing for the applicant named below without their explicit consent.

Based on the qualifying questions from Page 1

I affirm that all information provided in this document is true and correct as of the date on which this document was completed.

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We strive to respond to all applications within ten working days of receipt of this application. If you have any questions regarding the homes or services provided by Buffalo Harbor House.


If you have any additional questions regarding this application please feel free to message us.

Want More Information?

(716) 222-2103

info@buffaloharborhouse.com

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