Applicant Name - (Required)
Date of Birth
Day - (Required)
Month - (Required)
Year - (Required)
Co-Applicant (Please fill out if more than one applicant)
Date of Birth
By checking this box, I (We) hereby declare that the information given on this application is correct and/or complete and understand that this application does not constitute an agreement or lease with Bethel Mennonite Care Services, Inc., to provide accommodations. (Required)
*Bethel Place is committed to protecting your privacy and the confidentiality of your personal information. All information you provide to us shall be kept for the sole purpose of assessing and processing your application for residency.
*It is your responsibility to contact us annually to update your information, including a change in your readiness to move. We will begin the pre-admission process when you contact us indicating a readiness to move within 12 months.
*An assessment meeting is required for all applicants who have indicated a readiness to move. The purpose of the assessment is to provide transparency for communication between Bethel Place and the applicant to help discern housing placement. Family members pr advocates may accompany the applicant. A meeting with the applicant will be scheduled with Administration in order of the original application date and availability of apartments.