Waitlist | EMPOWERED LIVING SOLUTIONS

Join Our Waitlist

Looking for a safe, comfortable, and empowering place to live? Fill out the form below to join our waitlist. We’ll reach out with next steps and help you find the right fit.

Phone

(269) 743-4908

Email

info@info.empoweredcommunityliving.com

First name*

Last name*

Phone number*

Email*

Preferred Contact Method*

Phone

Email

If "Other" explain*

Can you independently manage your meals?*

Yes

No

Can you independently manage your medications?*

Yes

No

Do you require personal caregiving or supervised medical support?

Yes

No

Are you willing to live in a shared peer-support home?*

Yes

No

Expected Move-In Timeline:*

Within 30 days

1–3 months

3–6 months

6+ months

Emergency Contact Name*

Emergency Contact Phone*

Who referred you to us? (Name)*

What is your referral's phone number?*

what is your referral's email

Is there anything else you would like to share with us?*

Disclaimer & Attestation: By submitting this form, I certify that the information provided is true, accurate, and complete to the best of my knowledge. I understand that Empowered Community Living provides housing-only, peer-supported independent living and does not offer meals, caregiving, supervised medication, medical care, or clinical services. Participation is by program agreement, not a landlord-tenant lease. I authorize Empowered Community Living to contact me by phone, email, or text message regarding housing, referrals, or program participation. I may opt out of communications at any time by replying STOP or by contacting Empowered Community Living directly.*

I agree to the above disclaimer

Please note: Participants must be able to manage their own meals, medications, and self-care independently.