Squared Away Independent Living Community

Housing intake

Non-Medical Housing Intake

For the prospective resident or a caseworker assisting them. This is an inquiry form, not a housing application or guarantee of placement.

Referring a client as a caseworker or liaison? Use the partner referral form

Independent housing only — please read before continuing

Squared Away provides housing only. No assisted-living, personal-care, or hands-on support services are provided. Staff do not administer, dispense, or manage medications and do not provide bathing, dressing, toileting, mobility, meal-preparation, or other personal-care assistance.

Residents must be able to live independently or arrange their own supports from people or providers outside the housing service. The questions below help discuss whether the housing arrangement may fit; they are not a medical assessment and do not guarantee acceptance or placement.

Smoking is prohibited anywhere on the premises.

Clear pricing, confirmed before you apply. Rates vary by home and room type. We'll provide a written quote showing your monthly rent, deposit, included utilities and services, and approved room arrangement before you decide.

Privacy: Please do not enter medical history, diagnoses, Social Security numbers, account numbers, or other unnecessary sensitive details. Income, living-activity, and background answers are optional. Your form is sent securely and stored in a restricted system that only Squared Away staff can access. It is used only to review this housing inquiry and is never sold or shared. Email alerts to our staff include only your name and contact details — never your income, living-activity, or background answers.

Who is completing this form?

Prospective resident contact

Household and housing preferences

Preferred arrangement (select any that may work)

Current household arrangement

Who currently lives with you? Select all that apply. This helps us understand the household arrangement you are seeking.

Independent-living activities

Optional: these self-reported questions are only to discuss property features, reasonable accommodation requests, and supports arranged independently by the resident. They are not a medical evaluation or a pass/fail screening tool. Squared Away does not provide the assistance listed. You may choose “prefer not to say.”

Mobility and personal routines

Household activities

Income sources (optional)

Select any regular sources the prospective resident wants considered for housing budgeting. Do not provide Social Security or benefit account numbers.

Managing finances (optional)

Who usually handles rent payments and household budgeting? Do not provide bank, benefit, or account numbers.

Background information

Answering “yes” does not automatically disqualify anyone. We look at each person individually — including the nature and seriousness of any offense, how long ago it happened, and evidence of rehabilitation — and apply the same standards to every applicant.

Please do not include: arrests that did not lead to a conviction, sealed or expunged records, juvenile records, or minor traffic tickets. You may choose “prefer to discuss in person” for any question.

A pending charge is not a conviction and is never treated as one.

We ask only so we can plan for household arrangements and any agency or court requirements, such as approved living arrangements for children. An open case does not by itself disqualify anyone. Please do not share case details or any child's health information.

Background checks: If we use a background or consumer report to help make a housing decision, we will first ask for your separate written permission. If we take any adverse action based on a report, we will tell you, give you the name and contact details of the company that provided it, and explain your right to a free copy and to dispute anything inaccurate, as required by the federal Fair Credit Reporting Act.

Child information

Add one section for each child who may live in the household. Use first name or initials if preferred. Do not enter medical information.

Documents (optional)

Attach a photo ID and proof of income or benefits (pay stubs, SSI/SSDI or VA award letters). PDF or photos, up to 6 files, 10 MB each. Files are stored privately and only Squared Away staff can open them. Please cover Social Security and account numbers before uploading.

Follow-up and consent to contact

Independent housing only: Squared Away does not provide assisted-living, personal-care, medication-management, bathing, dressing, toileting, or mobility assistance. Residents must independently manage these needs or arrange their own outside supports. Functional responses do not by themselves determine eligibility; any accommodation request should be discussed individually. Smoking is prohibited anywhere on the premises, in accordance with property rules and applicable regulations. Housing options, amenities, rates, deposits, lease terms, and occupancy depend on the property and will be confirmed in writing before an application.

Equal Housing Opportunity & non-discrimination

Squared Away is committed to equal housing opportunity. We do not discriminate against any person on the basis of race, color, religion, sex, national origin, familial status (including households with children under 18 and pregnant persons), or disability, as required by the federal Fair Housing Act, or on any other basis protected by the Kentucky Civil Rights Act or Louisville Metro ordinances.

Every inquiry is reviewed individually using the same standards for everyone. People with disabilities may request a reasonable accommodation or modification at any time, at any step of the process — just ask us.

Prefer email? Write to squaredawayindependentliving@gmail.com.