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Phone No.

Date of Birth

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Teacher (or work) Experience

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No. of years

Town or City

State

No. of years

Town or City

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No. of years

Was your spouse a retired Texas educator?

Yes

If yes, name and experience:

Are there any conditions which might prevent you from taking care of your personal needs?

Will you be ready to move to Stilwell in the next 30 days?

Yes

If no, approximately when do you estimate you will be ready?

Please check the type of living arrangement desired:

Single Suite (for 1 person)

Double Suite (for 1 person)

Double Suite (for 2 people)

Nearest Relative

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Stilwell Retirement Residence provides equal opportunity housing

Financial assistance might be available. To request such assistance, a written statement as to a person’s income, expenses, and capital assets must be submitted to the Stilwell Board of Trustees. Any request for financial assistance will be strictly confidential.

Admission Procedure

1. Complete and return application to Stilwell
2.) Wait to be contacted about room availability.
3.) Once contacted, schedule a personal interview with the Stilwell administration.
4.) Decide to move in, and prepare to do so.
5.) Complete Admissions Agreement, Medical Information Sheet, and Designation of Responsible Party.
6.) Arrange for payment of your first bill.

I certify that I have fully stated all facts and that all the above information is true, to the best of my knowledge (please sign below with mouse cursor).

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Teacher (or work) Experience

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What Do Our Residents Say?

Your New Home Is Ready. The Welcome Matt is Out.