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What type of home do you live in? *

House Apartment / Condo Townhome Other

Do you own or rent your home? *

Own Rent Other

How many total bedrooms? *

1 2 3 4 5 6+

How many bedrooms are available for a person receiving services? *

0 1 2 3+

Is your home wheelchair accessible?

Yes Partially No Unsure

How many adults (age 18+) live in the home, including you? *

1 2 3 4 5+

How many children (under 18) live in the home?

0 1 2 3 4+

Do you have pets in your home?

Yes No

What is your experience supporting individuals with intellectual or developmental disabilities? *

Current Host Home Provider Former Host Home Provider Other caregiving / direct support experience No professional experience

What types of support needs would you feel comfortable exploring? (Check all that apply.) *

Independent living / minimal daily assistance Daily living and personal care assistance Mobility or accessibility support Behavioral or emotional support Medical or specialized care needs No preference — open to discussing different needs

How many individuals would you be interested in supporting? *

1 2 3 Open to options

Do you have reliable transportation? *

Yes No

When would you be interested in starting? *

As soon as possible 1–3 months 3–6 months Just exploring

If you move forward, Malachi Care will discuss additional screening, background checks (including applicable adult household members), training, a home review, and other approval requirements. These steps are completed separately through a secure process.

Acknowledgment

I understand this is an initial interest form and does not guarantee approval or a placement. I authorize Malachi Care LLC to contact me regarding next steps. *

Submit interest form