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1. Age of Child*

My child is:

pre-teen (12 years of age or younger)
youth (13-17)
young adult (18-25)
adult (26 or older)

1a. Child's gender:*

Female
Male

2. My child's disability is:*

3. Level of independence*

My child requires:

Limited care and supervision. Can care for self. No behavior problems. Will thrive in home like environment.
Regular care, supervision, and incidental training needs. Has some self-care skills and needs minimal assistance with activities of daily living. No major behavior problems, but may show mild behaviors (teasing, screaming, resistive) or mild non-compliance. Will thrive in home like environment.
Significant care, supervision, and ongoing training. Has significant deficits in self-help skills, and/or some limitations in physical coordination and mobility, and/or disruptive or self-injurious behavior.
Constant care, supervision, and professionally supervised training. Has deficits in self-help skills, and/or severe impairment in physical coordination and mobility, and/or severely disruptive or self-injurious behavior.

4. Timing of possible transition*

I can imagine my child transitioning from home:

As soon as possible
In the next few years
5 – 10 years from now
More than 10 years from now
Uncertain

5. To ensure a spot for my child*

I would consider purchasing a place before my child is actually ready to transition, and renting it out until we are ready.

Yes
No
Maybe

6. LU Community concept*

I think the LU Community concept is:

Interesting. For the right property, I would be prepared to invest.
A possiblity for my child. Need much more information.
Not of interest, thanks. Just looking.

7. Money, Honey*

For the right property, I could find some money to secure a home for life for my child. I have or could finance within a reasonable time:

$250,000
$125,000
Less than $100,000
I am unable to pay but would like to be on a renters’ waiting list.
Not interested. Thanks, anyway.

8. Deposit*

Would you be willing and able to pay a non-refundable deposit of $10,000 to secure a place for your child. It would give us cash to complete our pre-closing inspections.

Yes. I would consider paying a $10,000 deposit to reserve a place for my child.
I am not ready to reserve a place, but will make a tax-deductible donation to help defer costs.
No. Sorry. I prefer to watch.

9. Volunteer time*

Are you ready to devote volunteer time to this effort?

Yes, now, at the LU level, as advisor or committee member.
Yes, once a suitable property is found.
Maybe. It depends on my other time commitments.
No. Sorry. Busy.

10a. Integrated rural community*

Where would you rank an intentional community in a rural setting administered by LU (such as Clearwater Ranch near Cloverdale)?

First Choice
Second Choice
Third Choice

10b. Cluster of single-family homes*

Where would you rank a cluster of single-family homes in a suburban area administered by LU?

First Choice
Second Choice
Third Choice

10c. Multi-Unit apartments*

Where would you rank a shared apartment in an apartment building in which neurotypical tenants may also live, close to shops and other amenities (less rural and more urban) administered by LU?

First Choice
Second Choice
Third Choice

11. Distance*

For the right property, I could see my child living this distance from our home:

30 minutes or less
Up to 1 hour
1 – 2 hours
Distance matters less than finding a suitable place

11a. City in which you reside (helps us figure out acceptable distance)*

Parent Name*

First Last

First Parent Phone*

Second Parent Name

First Last

Second Parent Phone

Emails Address(es)*

(if more than one email, put a ; [semicolon] between each)

Additional Information

Any additional information you would like to share or message you would like to give us.

Name

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