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Front Porch Cohousing
Letter of Interest (FPC)
Letter of Interest (FPC)
Stephanie Moore
January 28, 2022
February 2, 2022
Please complete this form so that we can schedule a call to discuss your interest in our Neuro-Inclusive Cohousing Program.
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Contact Information
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Phone
How would you describe yourself?
(Required)
Select the most appropriate answer
Neurotypical
Neurodiverse
Other
Please describe your choice of 'other'
Resident Details
Name
(Required)
First
Last
Sexual Orientation
(Required)
Please choose
Male
Female
Choose not to answer
Preferred gender pronoun
(Required)
Please choose
He/Him
She/Her
Something else
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Age
(Required)
Primary IDD
(Required)
Select One
Please select the most appropriate answer
Autism Spectrum Disorder
Down Syndrome
Neuro-typical
Cerebral palsy
Fragile X syndrome
Other - Please describe
Please select the best option.
Primary IDD Other
Please describe your answer of other IDD
The resident's support needs are best described as...
(Required)
Please select the most appropriate answer
No Support – The resident independently can live alone and preform all activities of daily living without Direct Support Professional support.
Drop-in – The Resident needs a DSP to check in with them every few days or as requested; the individual is self-sufficient the majority of the time.r
Low – The resident needs a DSP to support them with a few tasks each day but can be self-sufficient for most of the day.
Moderate – The resident needs a DSP periodically throughout each day but can be self-sufficient for several hours at a time.
24/7 – The resident needs access to a DSP at all times but the DSP may be shared with others; they are not the only person receiving support from the DSP the majority of the time.
Daily medical support - The resident needs the attention of a medically trained/certified provider to safely complete daily routine care, such as assistance with eating, breathing (including durable medical equipment), etc.
Memory care - Due to symptoms of dementia or Alzheimer’s disease, the resident needs a safe environment, with extra structure and support to navigate the day
One-to-one - The resident needs the full attention and in-person support of at least one DSP at all times
High behavioral support - The resident needs specialized support(s) to mediate severe challenging behavior, significant adaptive skill deficits and medical/ behavioral issues to participate safely in home and community life. Examples of severe challenging behavior include aggression, selfinjury, pica, elopement and property destruction
The resident identifies as Neuro-typical
Coliving (Phase 1) vs. Cohousing (Phase 2)
Cohousing is an intentional community of private homes clustered around shared space. Each home has traditional amenities, including a private kitchen. Shared spaces typically feature a common house, which may include a large kitchen and dining area, laundry, and recreational spaces. Shared outdoor space may include parking, walkways, open spaces, and gardens. Households have independent incomes and private lives, but neighbors collaboratively plan and manage community activities and shared spaces. Coliving is similar, but all the people are living under one roof/a single-family home.
I am interested in the following type of community
(Required)
Please select one.
Please select the most appropriate answer
Cohousing (Phase 2)
Coliving (Phase 1)
Other
Other type of community
Please describe your choice of other type of community
Which county would the resident/applicant prefer to live in?
(Required)
Please select one.
Please select the most appropriate answer
Bucks County
Montgomery County
Lehigh County
Northampton County
Other
Other Counties of Interest
Please describe which other Counties are of interest to you or the resident/applicant
Acknowledgment & Consent
This document is non-binding. By completing and signing, it does not bind me to accept nor FPC to offer acceptance into their program. I intend at that time to complete the Front Porch Cohousing application process to determine if I or my dependent is eligible to live in the community.
Consent
(Required)
By checking this box and entering my initials below, I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to submit this document.
Today's Date
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Comments
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