Accessible Housing Program Application and Forms

All of the following forms must be completed and submitted to be considered for the Accessible Housing Program (AHP):

Accessible Housing Program Application 2026

► Intake Form (if you’re not already an Independence, Inc. consumer with an intake on file)

► Release of Information consent form

► Signed HIPAA acknowledgement form (return signature page only)


Along with your application, you MUST submit the following in order to be considered for the AHP:

► Proof of income for everyone in the household age 18+ that has ANY form of income to report (income must reflect previous 6 month period)

► Signed Landlord Agreement if home is a rental (located on page 2 of the application)


Read/download/print the following information we are required to share – acknowledgement of receiving this information must be marked on page 2 of the application:

► 2024 Accessible Housing Program Information Sheet

► Renovate Right Brochure

► Consumer Rights and Grievance Policy & Procedure


Questions? Contact Daniel Brown, Core Services Manager

► Email Daniel at dbrown@independenceinc.org

► Call 785-841-0333 ext. 121