Apply Now – harmonyheartsil.com

Before You Apply

Harmony Hearts is paid shared housing. We do not provide free housing, emergency shelter, or family housing. Children cannot reside at the property.

Applicants must have sufficient income or confirmed financial assistance to cover their housing payment. Harmony Hearts is a drug-free and alcohol-free environment. A criminal background check is required. Applicants with sexual-offense or violent-crime convictions are not eligible for placement.

Please review our Frequently Asked Questions before completing this application. You can view the Frequently Asked Questions on the Harmony Hearts website.

Harmony Hearts Intake Form

First Name

Last Name

Date of Birth

Phone Number

Room Preference

Private Room

Shared Room

Current Housing Situation

Desired Move-In Date

Do you require any accommodations due to a disability or medical condition?

Yes

Do You Smoke?

Yes

Do You Have Pets?

Yes

Income Source

SSI

SSDI

Employment

Sponsorship

Other

Monthly Income Amount

Have you ever been convicted of a felony?

Yes

Please briefly describe the conviction(s), including the type of offense and approximate year(s) of conviction.

Are you currently on parole or probation?

Yes

Case Worker

Yes

Agency Name

Case Manager Name

Case Manager Phone Number

Tell Us About Your Housing Needs/ Additional Information

Important Legal Acknowledgment

I certify that the information provided is true and accurate to the best of my knowledge. I understand that submitting an application does not guarantee placement or acceptance into a Harmony Hearts housing program.