Break The Cycle Properties
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Break The Cycle Properties
Home
About
Services
Application Form
Approval
Experience Break The Cycle Properties
Pre-Screen Application
Full Name*
Phone Number
Email*
Are you able to live independently and take care of yourself?
Yes
No
Need Assistance
Do you have reliable income (SSI,SSDI, JOB, etc)*
Do you have any history convictions or legal issues?
Yes
No
Are you currently taking any medications?*
Yes
No
Are you okay with living in a shared housing environment with other adults?*
Yes
No
Are looking for a private room or shared room?*
Shared room
Private room
Do you have a support system?*
Yes
No
Do you have a pet?*
Yes
No
Do you smoke or use any substances?
Yes
No
Are you comfortable with following house rules (no guests, no drugs/alcohol, quiet hours, etc.)?*
Yes
No
Submit Pre-screen Application
