Inquire Now

Fill out the form below to submit an inquiry about our Independent Living Program. Once received, we’ll review your information and follow up to discuss next steps and availability.

First name

Last name

Phone number

What is your source of income ? (SSI SSDI VA/Veteran Benefits or Other)

What is your monthly income ?

Referral agency

Are you able to live independently ?

Yes

What is your desired time frame for move in ?

Immediate

Within 30 days

1-3 months

Program Acknowledgment

Safe & Sound Support Services operates a program-based independent living model. Submission of this form does not guarantee placement.

I confirm that I am 18 years old or older.

Signature

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