CK Legacy Living LLC

Thank you for your interest in CK Legacy Living.

Please complete the application below to begin the intake process.

Basic Requirements
    •    Valid identification
    •    Willingness to follow house guidelines
    •    Commitment to maintaining a respectful environment

Application Process
    1.    Submit application
    2.    Intake review
    3.    Interview (if required)
    4.    Placement decision

Intake Form

We’re here to provide safe, structured housing and support. Please complete the form below so we can better understand your needs and determine how we can assist you.

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Name *

First

Last

Email *

Phone Number *

Email Address *

Current City & State *

the house Phone

What is your current living situation? *— Select Choice —HomelessStaying with family/friendsTemporary housingRentingOther

How soon do you need housing? *— Select Choice —ImmediatelyWithin 30 days1–3 monthsJust exploring options

Are you currently employed?Yes (Full-time / Part-time)NoThird Choice

Do you have a source of income? *— Select Choice —YesNo

Are you currently involved in any programs? *

(Optional text field)

Have you been referred by: *— Select Choice —Court / ProbationOrganizationFriend / FamilySelf

Why are you interested in our housing program? *

What are your goals while in the program? *

Are you willing to follow structured guidelines and house rules? *— Select Choice —YesNo

Do you require support in any of the following areas? *

• Employment assistance
• Life skills development
• Financial management
• Counseling / emotional support
• Substance recovery support
• Other

Emergency Contact Name *

First

Last

Relationship *

Phone Number *

I understand that submission does not guarantee placement and that all information provided is accurate. *

• I Agree

Submit