Apply for Admissions.

To apply for admissions to one of our affordable, assisted living communities you will need to fill out an application. You can apply online below or download our PDF application form and mail it. The online application is quick and easy via a secure form with data encryption so that all the information you provide is appropriately safeguarded.

If you are sending your application in the mail, please address it to one of the following:

New Standard Senior Living at Millville
1125 Village Dr.,
Millville, N.J. 08332
Call: 856-469-8192

New Standard Senior Living at Egg Harbor Township
6817 East Black Horse Pike,
Egg Harbor Township, NJ 08234
Call: 609-541-7701

New Standard Senior Living at Hammonton
308 S. White Horse Pike,
Hammonton, N.J. 08037
Call: 1-888-988-8642

Online Application for Admission

This application is for residency at the following location(s):

Millville, NJ

Hammonton, NJ

Egg Harbor Township, NJ

(Check all that apply)

Applicant's Name*(Required)

First Last

Applicant's Email*(Required)

Enter Email Confirm Email

Address*(Required)

Street Address Address Line 2 City State ZIP Code

Phone*(Required)

How long have you resided here?

Reason for moving

Does your current housing meet basic standards of health and safety?*(Required)

Yes

Emergency Contact Information:

Name*(Required)

First Last

Email*(Required)

Enter Email Confirm Email

Phone*(Required)

Does this person have Power of Attorney for the applicant?*(Required)

Yes

Legal documents showing Power of Attorney must be submitted with this application and retained on file for any applicant information to be released to the person listed above.

List ALL persons who will live in the apartment. List Head of Household first.

Head of Household Name*(Required)

First Middle Last

Head of Household Date of Birth*(Required)

US Citizen?*(Required)

Social Security Number*(Required)

Race

Hispanic?

Is there an Additional Occupant?*(Required)

Yes

Name(Required)

First Middle Last

Date of Birth*(Required)

US Citizen?*(Required)

Social Security Number*(Required)

Race

Hispanic?

At least one member of the household has a Social Worker/Case Manager

Social worker/case manager?

SW/CM Name:

SW/CM Contact Email:

SW/CM Phone Number:

SW/CM Facility:

INCOME & ASSET INFORMATION

Type of Income

Enter Gross Monthly Amounts. Enter zero for fields where there is no income.

Wages*(Required)

Unemployment*(Required)

Social Security*(Required)

Public Assistance*(Required)

Pensions/Annuity*(Required)

Disability/SSI*(Required)

Child Support/Alimony*(Required)

Other

Asset Information

Enter Total Value. Enter zero for fields that do not apply.

Savings Account(s)*(Required)

Checking Account(s)*(Required)

CDs, IRA, 401k, Etc.*(Required)

Stocks & Bonds*(Required)

Real Property*(Required)

Cash on Hand*(Required)

Any Other

Including Co-Head Income & Asset Information?*(Required)

Type of Income Co-Head

Enter Gross Monthly Amounts. Enter zero for fields where there is no income.

Wages*(Required)

Unemployment*(Required)

Social Security*(Required)

Public Assistance*(Required)

Pensions/Annuity*(Required)

Disability/SSI*(Required)

Child Support/Alimony*(Required)

Other

Asset Information Co-Head

Enter Total Value. Enter zero for fields that do not apply.

Savings Account(s)*(Required)

Checking Account(s)*(Required)

CDs, IRA, 401k, Etc.*(Required)

Stocks & Bonds*(Required)

Real Property*(Required)

Cash on Hand*(Required)

Any Other

Is the applicant EITHER currently enrolled in Medicaid OR intending to enroll in Medicaid in the next six (6) months?*(Required)

Yes

Does the applicant qualify* for assisted living and/or already live in an assisted living facility?*(Required)

Yes

All applicants will be required to undergo a physical examination no more than 30 days prior to beginning tenancy, in accordance with all rules and regulations set forth by the state of New Jersey Department of Health. Tenancy cannot be offered to applicants refusing a physical examination or those found to physically not qualify for an assisted living facility by standards set forth by NJDOH.

Have you or any member of the household ever been convicted of a felony?*(Required)

Yes

If yes, explain:*(Required)

Are any members of the household subject to a lifetime sex offender registration requirement in any state?*(Required)

Yes

ALL APPLICANTS WILL BE CHARGED $35.00 FOR THE PROCESSING OF A NATIONAL CRIMINAL BACKGROUND CHECK. PAYMENT CAN BE MADE BY CHECK OR MONEY ORDER, MADE PAYABLE TO “NEW STANDARD SENIOR LIVING”. APPLICANTS REFUSING A NATIONAL CRIMINAL BACKGROUND CHECK WILL BE AUTOMATICALLY DENIED.

Your signature(s) below serves as written permission for New Standard Senior Living to obtain a criminal background report for all applicants over the age of 18. The applicant(s) affirms that all information in this application is true and complete. The applicant(s) also understands that a personal interview must be held, and assets and income verified and approved. All information received is confidential. This application creates no obligation for the Landlord or applicant. After the application process is approved, a lease agreement must be signed by all applicants of legal age. If accepted, Applicant(s) certify this apartment will be their sole residence. The undersigned makes the foregoing representation knowing that if any of such proves false, New Standard Senior Living may cancel and annul any lease given in reliance upon such information.

All Applicants age 18 and older MUST sign this application.*(Required)

DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Date:*(Required)

Is a portion or all of the application is completed by someone other than the applicant?*(Required)

Yes

If a portion or all of the application is completed by someone other than the applicant, the following statement must be completed. I/We have completed all or part of this application at the request of the applicant(s):

Signature*(Required)

DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Date:*(Required)

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