Pre-Screening

Form

This pre-screening is the first step toward housing in Burlington, Alamance County.

Do you understand that WillowNest is a shared housing program with house guidelines, not a traditional rental? *

Yes. I understand

No. I need more information

Do you agree to contribute to a respectful, judgment-free living environment and follow all shared living expectations? *

Yes, I agree

No, I do not agree

Thank you for your response. Agreement to shared living expectations is required to participate in the WillowNest housing program. Based on your selection, we are unable to move forward with your application at this time. If you would like to talk it through, please call us at (919) 899-7885. *

WillowNest maintains a strict no controlled substances policy on the premises at all times. Are you able to comply with this requirement? *

Yes, I can comply with this requirement

No, I cannot comply with this requirement

Agreement to follow all house guidelines including the no controlled substances policy is required to participate in the WillowNest program. Based on your response we are unable to move forward at this time. If you would like to talk it through, please call us at (919) 899-7885. *

Our current home is a single gender home and all bedrooms are occupied by women. Would you consider a co-ed home if one becomes available? *

Yes

No, single gender only

No preference

First Name *

Last Name *

Date of birth *

Gender *

Shared rooms are assigned by gender.

Phone *

Email *

Your email will be used for background screening. Our screening company will send you an email to complete your background check, so please make sure this address is correct.

Address *

Street Address

City

State

How did you hear about us? *

Referred by

Referral contact number:

How soon do you need housing? *

Do you have a valid government-issued photo ID? *

Are you currently employed? *

Yes

No

Employer Name

Job Title

What is your total monthly income from all sources?

Room Type *

Shared, not available at this home

Private

Our Burlington home offers private rooms, from $1,000 a month. A coordinator will go through the available options with you.

What type of home do you prefer?

What is the best time to reach you? *

Morning (9 AM to 12 PM)

Afternoon (12 PM to 4 PM)

Evening (4 PM to 7 PM)

Agreement Checkbox *

I certify that the information provided is accurate and complete to the best of my knowledge.

By providing my number, I agree to receive automated or AI-generated calls and texts from WillowNest Independent Living, including marketing. Msg & data rates may apply. Reply STOP to opt out. Consent not required for services.

By checking this box, I agree to receive occasional marketing messages from WillowNest IL.

Looking for housing outside Alamance County? Join our waiting list at https://willownestil.com/waitlist

Privacy Policy | Terms of Service