Life Change Is Possible

AGMN Furnished Housing Application

Thank you for considering Adua Grace & Mercy Network Foundation (AGMN) for your short-term housing needs. We provide fully furnished rooms designed for professionals such as travel nurses, corporate contractors, and other individuals seeking a safe, quiet, and Christ-centered environment. Unlike hotels or Airbnbs, AGMN homes offer community, security, and a supportive atmosphere where you can focus on your work and well-being.

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Personal Information - Step 1 of 6

Name *

First

Last

Date of Birth *

Gender *

Phone Number *

Email Address *

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Emergency Contact *

Social Security Number (last 4) *

Driver’s License / Government ID Number

Expiration Date

State of Issue

Upload Copy of ID

Click or drag a file to this area to upload.

Desired Check-In Date *

Desired Check-Out Date *

Length of Stay *

Home Preference (if any)

Room Type

Occupation / Job Title *

Employer / Staffing Agency *

Work Assignment Location *

Upload Work Contract / Assignment Letter (optional but recommended)

Click or drag a file to this area to upload.

Do you have a valid driver’s license? *

Will you require a vehicle during your stay? *

AGMN partners with Adcon Rental Services LLC for discounted rentals

Do you smoke? *

Do you use alcohol? *

Do you use recreational or illegal drugs? *

Do you have any medical conditions we should be aware of (optional)?

Primary Care Doctor Name

Primary Care Doctor Phone

Housing Needs

Do you have any special housing requests? *

Will you require parking? *

Are you bringing any personal equipment/furniture? *

Please list

Fees & Payment Acknowledgment

• Application Fee: $50 (non-refundable)
• Security Deposit: $500 (refundable if no damages, unpaid balances, or contract violations)
• Weekly Rate: $230 / Room
• Monthly Rate: $800 / Room
• Background Check: $45

By submitting this application, I agree to the following:

1. I understand that my application fee is non-refundable under all circumstances.
2. I understand that my security deposit is refundable only if I leave the home in good condition, with no damages, unpaid balances, or broken agreements.
3. I agree to respect AGMN house rules, including: maintaining a safe, quiet environment; respecting other residents; and abstaining from drugs, illegal substances, and disruptive behavior.
4. I understand that furnished rooms include essential furniture and utilities, and I am responsible for maintaining them during my stay.
5. I agree that AGMN staff may conduct inspections to ensure cleanliness, safety, and compliance with house rules.
6. I understand that visitors must be approved in advance and that overnight guests are not permitted.
7. I understand that failure to follow rules may result in termination of my rental agreement, forfeiture of my deposit, and immediate removal from the property.
8. I acknowledge that AGMN provides transportation support at additional cost, through Adcon Rental Services LLC, and if I choose this option, I must comply with Adcon’s rental terms and conditions.
9. I understand that AGMN is a Christ-centered foundation and agree to respect the values and environment provided, regardless of personal beliefs.

Signature & Submission

Full Name (Typed) – Electronic Signature *

Date *

I have read, understood, and agree to the above terms and conditions. *

I have read, understood, and agree to the above terms and conditions.

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Life Change Is Possible

AGMN Furnished Housing Application

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