Enquire About Residency at Howard House

Do yo uknow someone who might be a good fit as a resident in Howard House? Please fill out the form below to send SDBIF your Howard House Residency request.

Contact Person's Information

First Name *

Last Name *

Email Address *

Phone Number *

Contact Preference *Please select an optionEmailPhoneEither works for me

Preferred Time of Day to be Contacted *Please select an optionMorning: 8am-12pm (PST)Afternoon: 12am-3pm (PST)Evening: 3pm-7pm (PST)

Potential Howard House Resident's Information

First Name *

Last Name *

Gender Identification *Please select an optionMaleFemaleNon-binary

Potential Resident's Age *

Requested move-in date *

Is the potential resident diabetic? *Yes, Type IYes, Type IINo, not diabetic

Does the potential resident need assistance from an ambulatory aide? (i.e. wheelchair, walker, cane, AFO) *YesNo

What is the level of care needed for the potential resident? (i.e. help with using the restroom, taking a shower, feeding, etc.) * *

What are you and the potential resident looking for in an assisted living home environment? *

Are you and the potential resident comfortable working with male and female caregivers? *Yes, either is fineNo, only female caregiversNo, only male caregivers

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