Apply for Housing

Referral & Intake Packet

Complete the form below to apply for transitional housing at Blu Manor. All fields marked with * are required.

What to Expect

Submit your application Takes about 5 minutes

We review and follow up Within 1 business day

Complete documentation & intake Finalize your paperwork

Move in Often within days of approval

Client Information

Please provide your basic contact and personal details.

Full Name *

Please enter your full name.

Date of Birth *

Please enter your date of birth.

Phone Number *

Please enter a valid phone number.

Email Address

Please enter a valid email address.

Current Address *

Please enter your current address.

Supervision Status

Select your current supervision status.

Supervision Status *

Probation

Parole

Pretrial

None

Referring Agency / Officer

Officer Phone / Email

Employment / Income Verification

Tell us about your current employment and income.

Employer Name *

Please enter employer name or indicate seeking employment.

Position / Title

Monthly Income *

Please enter your monthly income.

Work Schedule

Housing Details

Provide your expected move-in date and emergency contact.

Expected Move-In Date *

Please select an expected move-in date.

Emergency Contact *

Please enter an emergency contact.

House Rules Acknowledgment

Please review and acknowledge the following before submitting.

Residents agree to:

• Maintain employment or verified income
• Comply with supervision requirements
• Follow curfew and property guidelines
• Maintain cleanliness of shared spaces
• Abstain from illegal activity or prohibited substances

Violation of program rules may result in removal from housing.

I have read, understand, and agree to the House Rules *

Resident Signature

Type Your Full Legal Name *

Please type your full name as your signature.

Date

✓

Application Submitted!

Thank you for applying to Blu Manor. We'll review your application and contact you within 48 hours.

Need immediate assistance? Call us at 727-563-6540 or 727-710-6930

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Comprehensive Referral & Intake