Resident Application

This form is used for information gathering only.  No acceptance of admission by resident or facility is implied or agreed upon by completion of this form.  All information on this form is confidential and used only for determining eligibility for admission to Jamie’s Place Adult Family Home.  No funds are accepted as part of this information gathering.  All applications will be reviewed and contact will be made with the contact person listed upon an available room. The Admission Committee will review candidates with input from the leadership team and evaluation from RN if available. The Admission Committee is responsible for admission decisions.