Accessible Housing Program Application/Forms

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

AHP application 2022

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:

Accessible Housing Program Information Sheet 2021

Renovate Right Brochure

Consumer Rights and Grievance Policy & Procedure

Questions? Contact Daniel Brown, Core Services Manager


► Call 785-841-0333 ext. 121