Important Notice: This application is for a WAITING LIST ONLY. Due to high demand, Bright Gate Solutions requires 30–90 days notice before move-in. Submitting this form does NOT guarantee placement.

SECTION 1 – BASIC INFORMATION

Full Legal Name *

Phone Number *

Email *

Date of Birth *

SECTION 2 – RE-ENTRY STATUS

Are you currently in a halfway house or re-entry program? *

Yes

Name of Halfway House / Re-Entry Program *

Expected Release / Completion Date *

SECTION 3 – MOVE-IN TIMELINE (CRITICAL)

When are you realistically able to move? *

30 days

60 days

90 days

More than 90 days

Do you understand Bright Gate Solutions requires a 30–60 day move-in notice due to high application volume? *

Yes, I Understand

Criminal History

Registered Sex Offender *

Yes
No
No elements found. Consider changing the search query.
List is empty.

Arson Related Charges *

Yes
No
No elements found. Consider changing the search query.
List is empty.

Other Felony Charges Please List *

SECTION 4 – INDEPENDENT LIVING SCREENING

Do you require medical care, mobility assistance, or supervision? *

Yes

SECTION 5 – INCOME REQUIREMENTS

What is your current income source? (Select all that apply) *

Employment

SSI

SSDI

Veterans Benefits

Third-Party Program Payment

None

Income Amount? *

SECTION 6 – HOUSE RULE ACKNOWLEDGMENT

● No drugs, alcohol weapons and ammunition of any kind

● No guests inside the home

● Quiet hours

● Shared living rules

● This is not just a house, but a housing program.

● The program emphasizes guidance, structure, and accountability.

● The goal is to create a safe environment for everyone.

New residents will be in a shared room for 90 days after successful completion may be upgraded to private room.

Are- you willing to follow all house rules including: *

Yes

Do you understand violations can result in discharge?

Yes

If approved, I agree to pay a non-refundable move-in fee of $200, which covers items such as a new mattress, bed pillows, sheets, digital fingerprint setup, and administrative costs. * *

Yes, I Understand
No, I do not understand
No elements found. Consider changing the search query.
List is empty.

SECTION 7 – FINAL ACKNOWLEDGMENT

I understand this is a WAITING LIST application and placement is not guaranteed *

Yes