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If you would prefer, click the following link to download a paper version of the application. Send the completed application and attachments to:
ARCHCARE AT ST. TERESA
205 LEXINGTON AVENUE, 3RD FLOOR
NEW YORK, NY 10016

Receipt of all applications will be sent to the family member / guardian completing the application.

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or Medicaid plan to contact me.

USE THIS FORM TO APPLY TO ARCHCARE AT ST. TERESA HOUSING ON STATEN ISLAND

FAMILY MEMBER / GUARDIAN INFORMATION
APPLICANT'S INFORMATION
Please complete each of the following sections.
Section A
Section B
Additional Information
Please notify ArchCare at St. Teresa's in writing if the applicant is in need of a reasonable accommodation in order to comply with this application or lease.
Section C
Section D
Please provide a reference who has assessed or cared for the applicant. The reference will be contacted to provide an assessment of the applicant's appropriateness for independent housing.
Please rank the following services and choices in terms of importance to the applicant:

Application Process for ArchCare at St. Teresa

1. Completing Application
1.1 Applications will be accepted on a rolling basis and reviewed as they are received. Interviews will be held with potential residents and their families / guardians.
1.2 Based on the applications and on the interviews, a pool of potential residents will be created.
1.3 A lottery of the will be held to create a sequence for the offering of residency at ArchCare at St. Teresa’s.
1.4 Starting from number one in the sequence, four applicants from St. Teresa’s will be selected and then again starting at number one four applicants not already chosen will be selected from Staten Island and finally, if there are still units available, applicants from off Staten Island will be chosen. (New York City only)

2. After selection
2.1 The chosen applicants will be offered units in the building. If any turn down residency, the pool will be used to select the next applicants to be offered residency.
2.2 Those chosen and accepted residency will work with staff to provide funding information and to work toward adjusting self-directed funding to meet the funding needs for residency.
2.3 Chosen applicants will be provided with draft leases for review and signatures.
2.4 It is anticipated that the interview process will be on going and that the lottery will be held three months prior the completion of the renovations and move-in.
2.5 Tours of the completed building will be provided in advance of move-in and lease signing so residents can see the units assigned to them.

Form developed by ArchCare © 09-24-2018