IL Application First Name (Resident 1) Last Name First Name (Resident 2) Last Name Phone Email US States - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip Marital Status Single Married Divorced Widowed Emergency Contact Name Emergency Contact Phone Religious Affiliation (optional) Former Occupation(s) What is your desired Date of Occupancy? Health Status: List any serious illnesses or chronic physical problems you or your spouse may have Hobbies, Pastimes, Social Interests, Talents, etc.: Divider VILLAS VILLAS Blue Ridge (1 bedroom, 650 sq. ft.) First Preference Second Preference Third Preference Augusta (2 Bedrooms, 850 sq. ft.) First Preference Second Preference Third Preference Virginian (2 Bedrooms, 2 Bathrooms, 1300 sq. ft.) First Preference Second Preference Third Preference Virginian (2 Bedrooms, 2 Bathrooms, 1300 sq. ft.) Copy First Preference Second Preference Third Preference Garage (if available) for Blue Ridge/Augusta First Preference Second Preference Third Preference Divider Copy SKYLINE TERRACE SKYLINE TERRACE Unit A: The Woodland (Efficiency) First Preference Second Preference Third Preference Unit B: The Magnolia (1 Bedroom, 1 Bath) First Preference Second Preference Third Preference Unit C: The Dogwood (2 Bedroom, 1 Bath) First Preference Second Preference Third Preference Floor Preference First Floor Second Floor Third Floor Any Floor Divider Copy Copy SHENANDOAH TERRACE SHENANDOAH TERRACE The Washington (1 Bedroom, 1 Full bath) First Preference Second Preference Third Preference The Monroe (1 Bedroom, 1 Full Bath) First Preference Second Preference Third Preference The Jefferson (2 Bedrooms, 1 1⁄2 Baths) First Preference Second Preference Third Preference The Wilson (2 Bedrooms, 2 Full Baths) First Preference Second Preference Third Preference The Madison (2 Bedrooms, 2 Full Baths) First Preference Second Preference Third Preference Floor Preference Copy First Floor Second Floor Third Floor Any Floor Divider To be placed on the first priority waiting list, a non-refundable deposit of $1000.00 is required.. This deposit is applied toward the security deposit at move in. There is a one month security deposit required at lease signing. Apartments are available for lease on a 12 month contract basis. There is no entry fee. All residents are subject to the rules and regulation of the facility. I am sending a deposit in the mail in the amount of $1000.00 I am NOT sending a deposit, but wish to be on your general waiting list for an Independent Living unit in the future. If you are a human seeing this field, please leave it empty.