Welcome to Waymaker Co-Living.

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Personal Information

First Name *

Last Name *

Date of birth *

Email *

Phone *

Best way to reach you *

Call

Text

Best time to reach you *

Morning (8am-12pm)
Afternoon (12pm-5pm)
Evening (5pm-8pm)
Anytime
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By checking this box, I consent to receive non-marketing text messages from Waymaker Co-Living about my application. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others from Waymaker Co-Living at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

Military Service

Are you a Veteran or Active Duty Service Member? *

Yes - Honorably Discharged

Yes - Other Discharge

Active Duty

Guard/Reserve

No - Not a Veteran

Branch of Service

Army
Navy
Air Force
Marines
Coast Guard
Space Force
N/A
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Are you a Disabled Veteran?

Yes - I have a Service Connected Rating by the VA

In-Process / Pending

Prefer Not to Say

VA Disability Rating (if applicable)

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Not Rated
In-Process / Pending
Prefer Not to Say
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Are you enrolled in VA Healthcare?

Yes

Not Sure

Economic Assistance

Types of assistance you are currently receiving. This is a required field if you are currently unemployed.

Are you currently receiving Social Security? *

Yes

Are you currently receiving Social Security Disability Insurance/SSDI? *

Yes

Are you currently receiving Unemployment Benefits? *

Yes

Current Situation

Current Housing Situation *

Currently Housed
Life Change (i.e. Divorce, Separation)
Living with Friend/Family
Shelter/Transitional
Homeless
Other
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Current or Most Recent Address *

City *

State *

Country *

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Postal Code *

Do you have Dependents? *

Yes - Spouse

Yes - Children

Yes - Both

Yes - Other

Are you currently Employed? (select all that may apply) *

Full-Time
Part-Time
Self-Employed
Unemployed (searching)
Unemployed (not searching)
I receive VA Disability and/or Social Security (SS) Income
Student
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How do you plan to pay rent? (select all that may apply) *

Employment
VA Disability
Social Security/SSDI
GI Bill/BAH
Savings
Family Support
Housing Voucher
Other
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Estimated Total Monthly Income (all sources) *

Under $500
$500 - $999
$1,000 - $1,499
$1,500 - $1,999
$2,000 - $2,999
$3,000+
Prefer not to say
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Desired Move-In Date *

Intended Duration of Stay *

1-3 Months
3-6 Months
6-12 Months
12+ Months
Not sure yet
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Room & Preferences

Which Room Type interests you? *

Shared Room (most affordable)

Private Room

Private Room + Private Bathroom

Primary Suite (shared)

No preference

Occupancy: Who do you need a Room for? *

Only Me

Me +1 or more other people (Spouse/Significant Other, Child, Co-Worker, Relative)

Background & Agreement

Have you ever been evicted?

Yes

Is there anything in your Background that we should know about?

No criminal history

Misdemeanor

Felony

Prefer not to disclose

*A criminal record does not disqualify you. We evaluate each situation individually.

Are you on Probation or Parole?

Yes

Tell us about your situation...

Your goals, timeline, what you're looking for.

How did you hear about us? *

VA Office/Case Manager
Non-Profit/Community Organization
Friend/Family
Social Media
Google
Referred by a Resident
Other
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Referring Organization Name (if applicable)

Referring Case Manager Name (if applicable)

Case Manger Phone and/or Email (if applicable)

Do you have any additional questions, comments, concerns about our application process?Or if there's anything additional you'd like us to know or take into consideration, please input here.

Sober Environment Acknowledgement *

I understand that all Waymaker Co-Living maintain a sober living environment (zero tolerance for drugs and alcohol) and I am willing to abide by all house rules as a condition of residency.

Electronic/Digital Signatures Acknowledgemen *

All parties consent to executing or accepting agreements by electronic or digital means and agree (i) documents executed or accepted in such manner shall be considered as legally binding and shall be treated as originally written, signed documents, and (ii) agree not to raise, and agree to waive the use of electronic transmission or electronic signatures as a defense to the binding nature of such agreements.

Applicant Signature *

Clear

Apply for a private room in a modern, shared home