Resident Admission

Apply for Residential Services

Thank you for your interest in Living Challenge Inc. Please complete the form below to begin the admission process. Our intake team will review your application and follow up within two business days.

Before You Apply

Admission to our Supported Living Services program requires a Minnesota DD Waiver, CADI Waiver, or Elderly Waiver. Referrals are accepted from county case managers, waiver service coordinators, families, and guardians. If you have questions about eligibility before applying, please contact our intake team.

(952)922-8466 [email protected]

Admission Application

All fields marked with an asterisk (*) are required.

Applicant Information

Applicant's Full Name *

Date of Birth *

Gender

Primary Diagnosis / Disability *

Secondary Diagnosis / Co-occurring Conditions (optional)

Waiver & Funding

Waiver Type *

County *

County Case Manager / Waiver Coordinator Name *

Case Manager Phone

Case Manager Email

Guardian / Family Contact

Contact Name *

Relationship to Applicant *

Contact Phone *

Contact Email

Support Needs

Level of Support Needed *

Mobility & Physical Support Needs (optional)

Communication Needs (optional)

Behavioral / Mental Health Notes (optional)

Medical / Health Notes (optional)

Additional Information (optional)

By submitting this form, you consent to Living Challenge Inc. contacting you regarding this admission inquiry. Information provided will be kept confidential.

Questions? Contact our intake team or call us at (952)922-8466.