First Name

Last Name

Email *

Phone *

1. Are you looking for housing for yourself or for someone else? *

Yes

No

2. We can discuss affordability of our packages and options, with a range in cost from $695 - $2,000 per month. Are you or your client on SSI or SSDI? *

Yes

No

3. Or will you or your client have someone that will pay on their behalf? *

Yes

No

If yes, who? *

4. Grace Habitat actively collaborates with organizations to facilitate partnerships, including placement and/or other opportunities and services. Do you or your client require care services? *

Yes

No

If yes, what kind? *

Non-medical homecare
Therapy services
VA assistance
Transportation services
Group / Social activities
other
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