RESIDENTIAL APPLICATION PROCESS

Mae House is an Adult Residential Facility (ARF) serving women with developmental disabilities in Newport Beach, California. Licensed by the California Department of Developmental Services and designated by the Regional Center of Orange County as a Level 3 service-of-care facility, Mae House operates as a nonprofit organization since 2018. Mae House is dedicated to helping each resident live with dignity, purpose, and meaningful connection.

The decision to enroll in a life-long residential community is a significant one. The Mae House application process reflects this. Admission decisions are made based on the “goodness of fit” between the applicant and the program. To establish this, the following information is required:

Completed application form from family on behalf of applicant
Three personal and/or academic/employment references
Reports from the most recent program attended if applicable
Recent psycho-education battery that includes a cognitive evaluation, academic assessment and projective testing

Once the above information is received and reviewed, a decision will be made if the applicant is invited to proceed in the application process.

On-Site Interview: As the next step, an interview and tour will be scheduled. During this time, specifics of the program will be outlined. The applicant and the family will have an opportunity to discuss any questions and/or concerns they may have.

Pre-placement Stay: The next stage will be an invitation for a 7-day pre-placement stay. The pre-placement stay will allow the applicant to participate in a typical week at Mae House. Additionally, the Mae House team will have the opportunity to determine the applicant’s response to the program and compatibility with the current Members.

Any next/final steps will be determined on a case-by-case basis.

Please note: Mae House admission decisions are made without regard to race, color, national origin, ancestry, or religion.

APPLICATION FOR ADMISSION 2026

ATTENTION: you will be asked to upload a PDF of your PARENTAL/GUARDIAN STATEMENT to this form, you should probably start there and have it ready. Here are the required elements.

This field is for validation purposes and should be left unchanged.

Applicant Information:

Date of Application:

Name of Applicant:(Required)

First Middle Last

Nick Name:

Your Address

Street Address Address Line 2 City ZIP Code

Cell Phone:(Required)

Can text messages be sent to this number?

D.O.B.

Family Information:

Name of Father:

First Middle Last

Address (if different than above):

Street Address Address Line 2 City State ZIP Code

Cell Phone:

Can text messages be sent to this number?

Yes

Alternate Phone:

Father's Email:

Name of Mother:

First Middle Last

Address (if different than above):

Street Address Address Line 2 City State ZIP Code

Cell Phone:(Required)

Can text messages be sent to this number?

Yes

Other children in family:

Name:

Please indicate any family situation of which we should be aware:(Required)

Referral Information:

Who referred you to Mae House or how did you learn about the program?

Name

First Last

Relationship (optional):

(e.g., consultant, physician, friend, etc.)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Applicant Education/Prior Program Information:

Name of current program (if any):

Program contact:

Position:

Program address:

Street Address Address Line 2 City State ZIP Code

Former Schools or Programs Attended:

Name:

Dates Attended:

Name:

Dates Attended:

Has the applicant ever been dismissed or suspended from any program?

Yes

If yes, please state the circumstances and date:

Medical Information:

Regional Center of Orange County Service Level Designation: (if applicable)

Is the applicant now or has the applicant been under the care of a psychologist, psychiatrist or other professional counselor? If yes, please provide the name and address of the attending professional and reason for consultation.

Attending Professional:

Street Address Address Line 2 City State ZIP Code

Telephone:

Fax:

Reason for consultation:

What diagnoses have been given regarding applicant’s learning disability?

What is the applicant’s medication history (current and past)?

Does the applicant have any history of behavioral or emotional difficulties in school/program or residential settings?

Yes

If yes, please describe:

PARENTAL/GUARDIAN STATEMENT:

On a separate sheet, please answer the following questions.

Please describe your hopes and goals for the applicant’s future. How do you think living at Mae House will help in the attainment of these goals?
Please describe the applicant’s areas of strength and how she will be an asset to the Mae House community.
Please describe the applicant’s challenges in the following areas:

Social
Accepting directions
Employment
Staying Focused
Relationships
Grooming
Anger Management
Use of transportation
Independence
Money Management or Purchasing Skills
Use of free time
Cooking and kitchen skills

Signature of Applicant:

Date

Signature of Financially Responsible Party:

Date

Upload your Parental/Guardian Statement here:

Accepted file types: pdf, Max. file size: 2 GB.

In PDF format, thanks.

RESIDENTIAL APPLICATION PROCESS