/

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 interest list as soon as possible. Filling out this form will secure your place on the waiting list. 

Name of Core Member *
Name of Core Member
Your name *
Your name
Relation to Core Member *
Home Address *
Home Address
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?