Indie Tree Interest Form

Please verify the interested applicant meets the following resident descriptions:
Is 19-40 years old
- Yes
- No
Has a diagnosed intellectual or developmental disability
- Yes
- No
Is able to complete his/her daily needs
(bathing, dressing, feeding), access his/her physical environment, and live independently with some assistance
- Yes
- No
Communicates needs effectively
- Yes
- No
Works, volunteers, or is enrolled in a community college, or a day program
- Yes
- No
Is accustomed to contributing to “family-style” chores and activities, such as cooking and cleaning *
- Yes
- No
Enjoys interacting, socially, and respects social boundaries of others *
- Yes
- No
Is comfortable with a dynamic schedule, including attending on-campus and community-based events *
- Yes
- No
Is able to show proof of income
(proof of income may include pay stubs, social security information, 1099’s, etc.)
- Yes
- No
* These skills will continue to grow as the residents adjust to campus life

Parent/Guardian 2
Parent/Guardian 2 Name
First Last
Is the Parent/Guardian 2 address the same as the Parent/Guardian 1 address?*
- Yes
- No
Parent/Guardian 2 Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian 2 Home Phone
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Email

Submission & Application Fee
The application fee of $125 helps us cover our basic costs of processing your application. Once your application is submitted you'll have the opportunity to start to payment process which will be processed separately as a tax deductible donation.
*
I understand and agree to submit my application and continue to the payment portal

Please verify the interested applicant meets the following resident descriptions: