SECTION 1: PERSONAL INFO

First Name *

Last Name *

Email *

Phone *

Date of birth *

Address

Street Address

City

State

Country

Postal Code

Gender

Social Security Number

Government-Issued ID Type & Number

SECTION 2: HOUSING REQUEST

Room Preference

Move-In Date

How did you hear about us?

SECTION 3: CURRENT LIVING

If Other, please explain

Time in Current Situation

Housing Deadline

SECTION 4: INCOME & BENEFITS

Monthly Earnings

$

Income Payment Date (when do you receive funds?)

Do you have a representative payee or third-party payer?

Yes

No

SECTION 5 — BACKGROUND INFORMATION

Do you have any of the following? (Check all that apply)

Mental Health

Disability

Substance Recovery

Criminal History

Optional additional context

Sex Offender

Yes

No

Do you have any pending legal matters that may affect your ability to maintain stable housing?

Yes

No

SECTION 6 — HOUSING HISTORY

Have you ever been evicted?

Have you ever been asked to leave a group home, shelter, or transitional housing?

Yes

No

Please explain briefly

Previous Address (most recent):

Dates Lived There

Landlord / Property Name

Reason for Leaving (Please explain)

SECTION 7 — PERSONAL REFERENCES

Reference 1:

Reference 1: Full Name

Relationship with Reference 1

Reference 2: Full Name

Relationship with Reference 2

SECTION 8 - APPLICANT ACKNOWLEDGMENT

By signing this application, I acknowledge the following:

✦ The information I have provided is true and complete to the best of my knowledge.
✦ Nurture Bridge LLC may verify any information provided in this application, including conducting background and reference checks.
✦ Submitting this application does not guarantee placement. Acceptance is at the sole discretion of Nurture Bridge LLC.
✦ I understand that Nurture Bridge LLC operates as a rooming house under Georgia innkeeper law (O.C.G.A. Title 43, Chapter 21). If accepted, I will be a guest / licensee, not a tenant under a lease.
✦ I understand this is independent shared housing. Nurture Bridge LLC does not provide assisted living, personal care, nursing care, medication management, transportation, or supervision.
✦ I confirm that I am able to perform my own activities of daily living independently.
✦ If accepted, I agree to sign the full guest agreement set (Rooming House Occupancy Agreement, Licensee Agreement, Period of Occupancy Statement, and Fair Housing & Disability Accommodation Statement) and to follow all House Rules in the Guest Handbook.
✦ I authorize Nurture Bridge LLC to share information from this application with referring caseworkers, advocates, or partner organizations as necessary to coordinate placement.

Occupant Applicant Signature

Clear

Privacy Policy | Terms of Service

Nurture Bridge

Serving Athens and Northeast Georgia, Nurture Bridge welcomes partnerships and referrals nationwide and proudly accepts clients from across the United States.

Nurture Bridge does not discriminate in admission, continued residency, or services based on race, color, creed, national origin, age, sex, gender identity, marital status, sexual orientation, disability (including blindness), or any other status protected by law.

Nurture Bridge

Serving Athens and Northeast Georgia, Nurture Bridge welcomes partnerships and referrals nationwide and proudly accepts clients from across the United States.

Nurture Bridge does not discriminate in admission, continued residency, or services based on race, color, creed, national origin, age, sex, gender identity, marital status, sexual orientation, disability (including blindness), or any other status protected by law.

Nurture Bridge

Serving Athens and Northeast Georgia, Nurture Bridge welcomes partnerships and referrals nationwide and proudly accepts clients from across the United States.

©2026 by Nurture Bridge

Nurture Bridge

Serving Athens and Northeast Georgia, Nurture Bridge welcomes partnerships and referrals nationwide and proudly accepts clients from across the United States.

Nurture Bridge does not discriminate in admission, continued residency, or services based on race, color, creed, national origin, age, sex, gender identity, marital status, sexual orientation, disability (including blindness), or any other status protected by law.

©2025 by Nurture Bridge