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MENU
MENU
Lifestyle Options
Rehabilitation & Transitional Care
Assisted Living
High Acuity Assisted Living
Memory Care
Independent Living
What lifestyle option is right for me?
Communities
The Heights Assisted Living
Heights Town Homes
Cass Street Assisted Living
Riverside Transitional Care
Eagle Crest North
Eagle Crest South
Hearten Houses
The Willows
ECC Life
ECC Life Events
Facebook
Current newsletter
Request a Tour
Contact Us
Home
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Apply for Housing
Apply for Housing
Where Do I Start?
Whether you're planning ahead or have an interest now, the best time to consider moving to a senior community is when you're making your own decisions and are in optimal health. Waiting until a crisis occurs often leaves others to choose a community on your behalf that may not be your first choice, is a long distance from family or friends or provides less than ideal care. Determine what you need to live your best life and act now! Do your research, ask questions and schedule tours.
Contact the
Aging and Disability Resource Center
for information, connections to support and services for seniors and adults with disabilities in La Crosse County.
Apply to Eagle Crest Communities
Once you’ve made a decision to become a resident of an Eagle Crest Community, please submit the application below. If preferred, you may
download the PDF
and mail the completed form to Eagle Crest South.
Step 1 of 4
25%
Type of application
*
Ready list (Given availability of the right apartment/suite, I would be ready within 60 days)
Wait list (I’m not quite ready to move to a Eagle Crest Communities community, but I am planning for my future)
Expected time until transferring to ready list
*
2 years
5 years
10 years
Other
Please specify
Number of applicants
*
One
Two
Personal information
First applicant
Legal name
*
First
Middle
Last
Preferred name
*
Home address
*
Street address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP code
Phone (home/main)
*
Phone (cell/alternate)
Email
Date of birth
*
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Martial status
*
Married
Single
Divorced
Widowed
Domestic partner
Gender
*
Male
Female
Second applicant
Legal name
*
First
Middle
Last
Preferred name
*
Home address
*
Same as previous
Street address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP code
Phone (home/main)
*
Phone (cell/alternate)
Email
Date of birth
*
Month
1
2
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5
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10
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12
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1932
1931
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1926
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1921
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Marital status
*
Married
Single
Divorced
Widowed
Domestic partner
Gender
*
Male
Female
Emergency and/or alternate contact
First applicant
Name of contact
*
First
Last
Address
*
Street address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP code
Phone
*
Email
Relationship to applicant
*
Spouse
Son/daughter
Guardian
Family
Friend
Second applicant
Name of contact
*
First
Last
Address
*
Street address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP code
Phone
*
Email
Relationship to applicant
*
Spouse
Son/daughter
Guardian
Family
Friend
Lifestyle options
Lifestyle of interest
*
Assisted living
High acuity assisted living
Memory care
Rehabilitation and/or skilled nursing
Independent living apartments (for ages 55+)
Amenities of interest (check all that apply)
Social activities
Housekeeping
Medication management
Daily meal service
Laundry services
Transportation to medical appointments
Assisted living: communities of interest
The Willows, La Crosse (private pay only)
The Heights Assisted Living, Holmen
Eagle Crest North, Onalaska
Cass Street Assisted Living, La Crosse
Assisted living: Apartment style preference (check all that apply)
Studio
1BR
1BR+
2BR
High acuity assisted living: Communities of interest
Eagle Crest South, La Crosse (private pay only)
High acuity assisted living: Apartment style preference (check all that apply)
Studio
1BR
Memory care: Communities of interest
Hearten House I, La Crosse
Hearten House II, La Crosse
Hearten House III, La Crosse
Eagle Crest North, Onalaska
Eagle Crest South, La Crosse (private pay only)
Lighthouse of Bethany Riverside, La Crosse
Rehabilitation and/or skilled nursing: Communities of interest
Bethany Riverside, La Crosse
Independent living: Communities of interest
Eagle Crest South, La Crosse
Eagle Crest North, La Crosse
The Heights Town Homes, Holmen
Independent living: Apartment style preference (check all that apply)
Studio
1BR
1BR+
2BR
3BR+
In completing this application, I am aware that:
The information in this application will be used to determine eligibility for admission to Eagle Crest Communities.
Eagle Crest Communities will rely upon and is entitled to rely upon the accuracy of my statements.
I may be requested to update this application when Eagle Crest Communities considers it appropriate.
Have you ever been evicted?
*
Yes
No
Please provide circumstances.
*
Do you authorize Eagle Crest Communities to conduct a criminal background check of applicant(s)?
*
Yes
No
Do you authorize Eagle Crest Communities to conduct a registered sex offender check of applicant(s)?
*
Yes
No
Do you authorize Eagle Crest Communities to conduct a credit check?
*
Yes
No
Please note that if you do not allow Eagle Crest Communities to conduct a criminal background check, registered sex offender check and credit check, we are unable to process your application.
Capacity of signer
*
Self
Spouse
Guardian
Family
Friend
POA–Financial
POA–Health care
I declare that the information given in this application is true, full and complete.
Signature
*
Please type your full name.
Signature of second applicant
*
Please type your full name.
Date
*
Month
1
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Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920