Apply | Casa Joliska

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CASA = HOME

A place of safety, support, encouragement, accountability.

A place where our residents can start over with no judgement. Our residents come from all walks of life ranging from 18 yrs. - 60+ yrs. Each benefitting greatly from our beautiful, shared living environment that emphasizes on tranquility, respect for one another, teamwork, and compassionate encouragement for their own growth to heal with self-respect and the realization they have the power to change.

Download the Application

*Application and Eligibility Requirements

Client Intake Information

First Name

Birth Date

Last 4 of SSN

How did you hear about us?

Veteran

Yes

ID Card

Yes

SS Card

Yes

Income

Working

SSI

SSDI

DOC Housing Voucher

Other

Healthcare

Medicaid

WA Apple

Both

Other

Any Mental Health past or present and do you receive services:

Any Chemical dependency past or present and do you receive services:

Work History

Are you working or looking for work?

Type of work

Do you plan on school or training and what type of training:

Emergency Contact

1. Name

Relation

Address

Phone

2. Name

Relation

Address

Phone

Last Name

Phone

Barriers to Housing

Eviction:

Debt:

Other:

Incarceration or Arrest History

Any charges pending

Yes

N/A

Charge

County

Status

Charge

County

Status

DOC Number

Are you working with any other organization or case managers that are helping with resources?

Do you have any allergies?

What should we know about you to assist you?

Resident Signature

Thank you for your application!

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CASA = HOME

​A place of safety, support, encouragement, accountability.

Client Intake Information

Emergency Contact

Barriers to Housing

Incarceration or Arrest History

A place of safety, support, encouragement, accountability.