Getting to know you

Please fill out the form below if you would would like to be a part of CASS Housing.  Due to the high levels of interest, we recommend Core Members and their families apply to be a part of the waiting list as soon as possible. Filling out this form will secure your place on the waiting list. Please note, we are only accepting applications for Core Members within an hour radius of Fort Wayne, Indiana at this time. If you are outside this area and would like to have CASS come to your community, please connect with us!

Name of Core Member *
Name of Core Member
Your name *
Your name
Relation to Core Member *
Your Phone Number *
Your Phone Number
Perferred method(s) of contact *
Estimated time frame to move into a CASS home? *
Desired CASS Housing model?
Learn more at casshousing.org/models
Desired location of the home?
Does the Core Member have a Medicaid waiver? *
If yes, what waiver services are utilized?
Does the Core Member receive SSI or SSDI? *
Activities Core Member would enjoy participating in?
Phrases that describe the Core Member
Would you like to volunteer?