Pre-Screen Form – My WordPress

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Pre-Qualification

Pre-Screen Application

Complete this short form to begin the application process. Our team will follow up within 1-2 business days to discuss next steps.

Website

Personal Information

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address

Housing & Income

Current Housing Situation *

Room Preference *

Desired Move-In Timeline

Primary Income Source *

SSI (Supplemental Security Income) SSA / Social Security Veterans Benefits Disability Benefits Employment Income Other Guaranteed Income

Monthly Income Amount

Are You a Veteran?

Yes No

Program Fit

Are you willing to follow all house guidelines and agreements? *

Yes, I am committed to following the house guidelines No

Are you currently free from drugs and alcohol?

Yes No In Recovery

How did you hear about LightWork3r?

Additional Information / Special Circumstances

* Required fields. Your information is confidential and will only be used to assess your application for housing.

✦

Thank You for Applying!

We've received your pre-screen application. A member of the LightWork3r team will reach out within 1–2 business days.

In the meantime, feel free to call us at (816) 655-8717 or (816) 352-4546 with any questions.

Get In Touch

Ready to Take
the Next Step?

Our team is here to answer your questions and help you find the right housing solution. Don't hesitate to reach out — we'd love to hear from you.

📍

Address

4049 Pennsylvania Ave, Ste 203 PMB 1103
Kansas City, MO 64111

📞

Phone

(816) 655-8717
(816) 352-4546

✉️

lightwork3r1@gmail.com

Call Today to Apply

Ready to get started? Give us a call or submit the pre-screen form. Our team will walk you through the process and answer any questions about availability and program fit.

📞 (816) 655-8717 📞 (816) 352-4546

Complete the Pre-Screen Form Online →

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