Cornerstone Residential GroupSafe · Structured · Stable

Invitation Only · Confidential

Resident Intake Application

Please complete every required field. All information is kept confidential and used solely to evaluate your housing application with Cornerstone Residential Group.

Download printable PDFPrefer paper? Download, complete, and email to info@livewithcrg.com.

Application Progress

Eligibility
Personal Information
Housing History
Income & Employment
References
Background Information
Review
Direct Deposit
Signature

1. Applicant Information

Full legal name

Date of birth

Gender (optional)

Phone

Social Security Number

Your SSN is used only to run a background check as part of the application review. It is kept confidential.

2. Residence History

Current street address

City, State, ZIP

Time at address

Previous address (if less than 2 years)

Reason for leaving (optional)

3. Employment & Income

Current employer

Employer phone

Position / role

Length of employment

Monthly income

Other income sources (SSI, VA, pension, etc.)

4. Housing Preferences

All CRG properties are fully furnished. Select your preferred room type and desired move-in date.

Room type preference

Desired move-in date

Preferred city or area (optional)

5. Background Disclosure

Have you ever been evicted?

Any felony convictions in the past 7 years?

6. Emergency Contact & Reference

Emergency contact name

Relationship

Emergency contact phone

Personal reference (optional)

Relationship

Reference phone

7. Additional Notes

Anything else we should know? (optional)

8. Direct Deposit Authorization

Provide your bank information so any refunds, reimbursements, or approved recurring deposits can be handled electronically. Your banking details are kept confidential and used only for the purposes authorized below.

Account holder name (as it appears on the account)

Bank / financial institution

Account type

Routing number (9 digits)

Deposit type

Account number

Confirm account number

Tip: Your routing and account numbers are on the bottom of a check — routing (9 digits) first, then account number.

I authorize Cornerstone Residential Group to initiate electronic (ACH) credits, and if necessary corrections to those credits, to the account listed above at the financial institution named. This authorization remains in effect until I notify Cornerstone in writing to cancel it in such time as to give Cornerstone and my financial institution a reasonable opportunity to act on it. I certify that I am an authorized signer on the account.

Signature (type full name)

Date

9. Acknowledgements & Signature

I authorize Cornerstone Residential Group to verify the information provided in this application, including employment, rental history, references, and to conduct a criminal background check where permitted by law.

I understand there is a one-time, non-refundable $250 Program Administration Fee that covers application processing, background screening, administrative review, verification of information, and onboarding costs. Payment will only be requested if Cornerstone Residential Group determines I am eligible to move forward in the application process.

I understand that completion of this application does not guarantee placement, that Cornerstone reviews each applicant individually, and I agree to abide by Cornerstone's House Rules and Resident Expectations if approved for housing.

I certify that the information provided in this application is true and complete to the best of my knowledge.

I understand that providing false, misleading, or incomplete information may result in denial of my application or removal from the program if discovered after admission.

Signature (type full name)

Date

By typing my full legal name below, I acknowledge that this electronic signature has the same legal effect as my handwritten signature and confirms my agreement to all acknowledgements above.