Shared Community — 100% Private Rooms Only•No Shared Bedrooms•100% Drug & Alcohol Free
Two official forms · Free to complete

Start your screening.

Screening is how we get to know you and place you on the waiting list for a 100% private room — never a shared bedroom — in our drug- and alcohol-free shared community in Birmingham. Priority consideration is given to eligible veterans ages 55+.

Begin Step 1

Reviewed by our local Birmingham team · Confidential

Step 1 · Form A

Pre-Admission Screening Assessment

Tells our team about your housing situation, funding and self-care needs, so we can confirm the community is the right fit for you.

About 7 minutes
Step 2 · Form B

Official Waiting List Registration

Registers you on the official waiting list for a private room and confirms your move-in timeline.

About 5 minutes
Step 1 · Form A

Pre-Admission Screening Assessment

Covers your general information and referral details, your funding sources, and a short independent-living capability and policy agreement.

  • General information & referral details
  • Payment & funding source verification
  • Independent living capability & policy agreement
  • Screening authorization & signature
Prefer paper?

Download and print the official form, then email the completed copy to our team.

1

General Information & Referral Details

2

Payment & Funding Source Verification

Primary payment source(s)check all that apply
3

Independent Living Capability & Policy Agreement

Able to perform all activities of daily living (ADLs) independently in a structured community setting?
Does the applicant require on-site medical nursing or daily personal caregiver assistance?
Agrees to abide by a strictly 100% Drug- and Alcohol-Free residential agreement?
4

Screening Authorization & Signatures

Completion of this form does not guarantee program admission or housing placement.

Step 2 · Form B

Official Waiting List Registration

Registration on the official waiting list holds a prospective place for admission prior to the grand opening. You can complete this after Form A — or right now if you've already finished your screening.

  • Prospective resident information
  • Referral source & type
  • Housing timeline & accommodations
  • Registrant signature

Waitlist policies

Waitlist processing: registrations are processed chronologically upon receipt of Form A and Form B. Special priority is given to eligible U.S. veterans ages 55 and older.

Mandatory pre-screening: final admission is contingent upon approval of Form A, background verification, and an intake interview. Placement on the waitlist does not guarantee entry.

Contact updates: please notify us promptly of any changes to your phone number or address to maintain an active waitlist status.

Prefer paper?

Download and print the official registration form, then email the completed copy to our team.

1

Prospective Resident Information

Preferred contact method
2

Referral Source & Type

Submission type
3

Housing Timeline & Accommodations

Desired move-in timeline
Room type requested: Private Single-Occupancy Room (100% Private Bedrooms) — the only accommodation we offer.
4

Registrant Authorization

Completion of this form does not guarantee program admission or housing placement.

Please note: SXC Solutions LLC operates a 100% drug- and alcohol-free shared community with private rooms only (no shared bedrooms) in a structured setting for adults capable of independent self-care. Completion of this screening assessment does not guarantee program admission or housing placement.

Private rooms only100% drug & alcohol freeAbout 12 minutes total

Need a hand?

If any part of the forms is unclear, email our team and we'll walk through it with you.

info@sxcsolutions.org