Skip to content
Home
Living Options
Finding The Right Fit
Independent Living
Assisted Living
About
Our Story
Our People
Testimonials
Reel People of Golden West
Volunteer
FAQs
Careers
Foundation
About Donating
Lifestyle
Blog
Contact
Application – Towers
p1v0t
2021-11-01T16:10:09-06:00
The Towers at Golden West
Application for Residency
Applicant(s) Information
How did you hear about us?
*
Friend or family
Online advertisement
Internet (I found your website)
I don't know
Other
Name
*
First
Middle
Last
Phone
*
Email
*
Date of birth
*
MM slash DD slash YYYY
Address
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Racial categories
*
African American
American Indian or Alaska Native
Asian
Caucasian
Hawaiian or Pacific Islander
Hispanic or Latino
Non-Hispanic or Latino
Other
I prefer not to disclose ethnic or racial information
Other
*
Please Initial
*
Partnership status
*
Single
Married
Partnered
Divorced
Widowed
Second applicant's name
*
First
Middle
Last
Phone
*
Email
*
Date of birth
*
MM slash DD slash YYYY
Alternate contact
*
Relationship
*
Phone
*
Email
*
Address
*
Annual Income Information
Wages, commissions, fees received
*
Pension, retirement, annuity
*
Social Security
*
Old age assistance
*
Rents or royalties received
*
Interest on savings accounts
*
Dividends received on stocks, bonds, mutual funds
*
Other income
*
Assets
*
Total annual income
$0.00
Living Situation
Do you currently
*
Own
Rent
Live with family
Live in a retirement community
Present landlord or mortgage company
*
Phone
*
Monthly rent/mortgage payment
*
Date of move-in
*
MM slash DD slash YYYY
How soon are you contemplating a move?
*
ASAP
3-6 months
6-12 months
1-2 years
Unknown
Will you be parking a vehicle on the property?
*
Yes
No
Do you have a pet?
*
Yes
No
Breed
*
Weight
*
Do you currently receive housing assistance? (i.e. Section 8)
*
Yes
No
Do you currently live in subsidized housing?
*
Yes
No
Apartment Request
Please select the type of apartment you would prefer. Keep in mind that very limited preferences can prolong the waiting time.
*
Studio Apartment
One Bedroom
Either/both
Specific Floor(s)
*
Specific View(s)
*
Other Requirements (e.g. Specific Tower)
*
How did you hear about Golden West?
*
Google Search
Print Ad
Online Ad
Friend or Family Member
Driving By
Other
Pre-Assessment Checklist
At Golden West, we take great pride in our long-standing history, culture, and the services we provide to seniors. In order to continue to provide the best environment for our residents, we conduct background checks and income verification to help ensure that Golden West is a good fit. We hope that you will appreciate that the requested information helps us maintain a warm and welcoming environment for all residents.
Is the future resident 62 or older?
*
Yes
No
We have maximum income limits of $49,140 for a single person and $56,160 for a couple. Does your income fall within those limits?
*
Yes
No
The monthly fee for your desired apartment is $900 or $1,200 including local telephone service, expanded basic cable TV, and utilities, all of which are non-negotiable. Will this work within your budget?
*
Yes
No
Golden West will need a copy of your most recent bank statements and the Annual Social Security Benefit letter to verify income & assets to ensure our fee fits within your budget. Can you provide one, and additional verification if needed?
*
Yes
No
The Towers at Golden West is more than an apartment building. We have a resident council, floor representatives, resident committees, group activities and a daily check-in system. Neighbors are concerned about each other and if people don’t see you for some time, we might be asked to check on you. If you are going to be out of the building on vacation or due to medical reasons, we will want to know this. Will you be comfortable in this type of environment?
*
Yes
No
The Towers at Golden West is an independent living community and residents are responsible for their own wellbeing and for making sure their needs are met. The Towers does offer a voluntary dining program, a variety of activities and a resident services coordinator. Golden West is not a medical facility and we do not have doctors, nurses, physical therapists or any other medical personnel on staff and cannot provide any kind of medical care. Does this level of service meet your needs?
*
Yes
No
Golden West is a smoke-free community and no smoking is allowed anywhere on the property. Are you a smoker?
*
Yes
No
Can you comply with the smoking ban?
*
Yes
No
Have you or any of the applicants?
*
Check all that apply.
Broken a lease?
Had a lease terminated, been evicted or involuntarily removed from any housing or residential situation?
Declared bankruptcy?
Been convicted of a felony?
Been convicted of a violent crime, theft, or use of illegal drugs?
None of the above
Golden West will conduct a background check prior to move-in. Do you agree to this?
*
Yes
No
Signature
I declare that the above listed information is correct and true to the best of my knowledge. I also authorize Golden West to verify above information and/or obtain landlord, credit or criminal histories to determine eligibility. I understand that my application may be rejected if I have provided any false information.
Please enter your name to confirm and sign the application
*
First
Middle
Last
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
Δ
Construction News
Weekly Updates
Lifestyle
Events & More
Newsletter
Sign Up
×
Newsletter Sign-up
Name
*
First
Last
Email
*
Email
This field is for validation purposes and should be left unchanged.
Δ
Brochure
Download
Employment
Work for Us
Testimonials
Read More
Construction News
Weekly Updates
Lifestyle
Events & More
Newsletter
Sign Up
Brochure
Download
Employment
Work for Us
Testimonials
Read More
Toggle Sliding Bar Area
A
Decrease font size.
A
Reset font size.
A
Increase font size.
Important Update on COVID-19
Make a Donation
303.444.3967
Careers
Page load link
Go to Top
