Confidential Resident Application

Please complete the application below. Our team will carefully review your information and contact you shortly to discuss the next steps. We look forward to connecting with you and helping you find your next home.

    Confidential Financial Statement

    Application For


    Applicant Information


    Contact Person


    Marital Status and Insurance


    Monthly Income


    Assets


    Liabilities


    Assets Sold or Given Away Within the Last 5 Years


    Durable Power of Attorney for Finances


    Acknowledgment

    By submitting this form, I represent and warrant that the above information is true and correct and accurately reflects my financial condition and the funds that are available to pay for my care. I understand that Cedar Crest will be relying on the information provided herein and may terminate any and all agreements with me if I provide false or misleading information. I further give Cedar Crest permission to verify the information provided herein. I also understand that I may be required to provide updated financial information and agree to do so upon request. I believe I have adequate resources to meet my financial responsibilities, including those that will attach if I am accepted into Cedar Crest.


    If Prospective Resident Is Unable to Sign