Application

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D&K With Love Provides Shared Independent-Living Housing And Does Not Provide Meals, Transportation, Or Medication Management.

START YOUR APPLICATION

Let's Talk About Your
Next Home.

Have questions about available rooms, monthly costs, eligibility, or the application process? D&K With Love is here to help you understand your housing options and take the next step with confidence.

1. APPLICANT INFORMATION

FULL NAME*

CURRENT ADDRESS*

CITY/STATE / ZIP*

PHONE*

DATE OF BIRTH

Day

Month

Year

EMAIL*

2. HOUSING REQUEST

DESIRED MOVE-IN DATЕ*

REASON FOR SEEKING HOUSING*

HOW DID YOU HEAR ABOUT D&K WITH LOVE?*

3. INCOME/ ABILITY TO PAY

DO YOU HAVE A REGULAR SOURCE OF INCOMЕ?*

YES

NO

SOURCE OF INCOME*

APPROX. MONTHLY INCOME*

CAN YOU PAY YOUR HOUSING COST EACH MONTH?*

YES

NO

4. EMERGENCY CONTACT

CONTACT NAME*

RELATIONSHIP*

PHONE:*

ALTERNATE PHONE:

5. INDEPENDENT LIVING

CAN YOU LIVE INDEPENDENTLY WITHOUT PERSONAL CARE STAFF?*

YES

NO

CAN YOU MANAGE YOUR OWN MEDICATIONS?*

YES

NO

CAN YOU PREPARE OR OBTAIN YOUR OWN MEALS?*

YES

NO

CAN YOU ARRANGE YOUR OWN TRANSPORTATION?*

YES

NO

CAN YOU FOLLOW HOUSE RULES?*

YES

NO

DO YOU NEED AN ACCESSIBILITY ACCOMMODATION?*

YES

NO

IF YES, EXPLAIN:

6. CURRENT HOUSING

WHERE ARE YOU CURRENTLY LIVING?*

REASON FOR LEAVING:*

LANDLORD / PROGRAM CONTAСТ:*

PHONE:*

7. REFERRAL INFORMATION

REFERRING AGENCY:

CASE MANAGER / SOCIAL WORKER:

PHONE / EMAIL:*

8. ADDITIONAL INFORMATION

ANYTHING MANAGEMENT SHOULD KNOW:*

9. CERTIFICATION

I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND COMPLETE. I UNDERSTAND D&K WITH LOVE IS AN INDEPENDENT LIVING HOUSING PROGRAM.

APPLICANT SIGNATURE:*

DATE:

D&K With Love provides clean, comfortable, and affordable private and shared rooms for independent adults seeking stable housing in Detroit, Michigan.

Quick Links

Contact Info

Detroit, Michigan

Phone: +586 -225-5211
Email: dandkwithlove@gmail.com

Mon -Sat: ( 8am - 6pm )
Sunday: CLOSED

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Application

Application

Let's Talk About Your Next Home.

Let's Talk About Your
Next Home.