Valdura Capital LLC house markValdura Capital LLCIndependent Living Homes
Intake Form

Intake Form

Let's get to know you

This form helps us understand your situation and what you're looking for. Answer as best you can — we'll follow up with current availability and next steps.

1

About you

A few basics so we know who we're talking to.

We'll email you a copy of your form.

2

Your housing situation

Where things stand today and when you need a place.

Do you understand this home is for single occupancy only (one resident per bed/lease)? *
Are you requesting housing for anyone other than yourself? *
3

Income and payment

How you'll cover rent — we accept many income sources.

Source(s) of income *
Would you be able to provide proof of income? *
4

Day-to-day living

Our homes are for people who manage their own daily lives.

Are you able to live independently without daily assistance? *
Do you understand that housing is in shared rooms only? *
Do you currently receive help with daily activities (cleaning, cooking, hygiene, etc.)? *
Would you need transportation assistance?
Do you have your own vehicle? *
Do you have a valid identification card? (Driver's license, state ID, passport, etc.)

Valdura Capital LLC provides housing only — no personal care, medical services, or supervision.

5

Confirmation and acknowledgment

One last look before you send it in.

Valdura Capital LLC is a shared living program. By entering this housing environment you are agreeing to participate in a structured, supportive setting designed to help you build stability, independence, and healthy routines.

Do you understand and agree? *
How do you prefer to be contacted? *

Typing your full name confirms the information above is accurate to the best of your knowledge.

Valdura Capital LLC provides housing. We do not provide personal care, medical services, or supervision.