On My Own

Making independent living possible for people with developmental disabilities

To complete the next step in determining your eligibility for our programs, complete the below application and submit your $100 non-refundable application fee.

Once we’ve received your application and payment, we’ll contact you to begin the next step in the process.

If you have any questions as you complete the application, please contact Emily Lourim at emily@onmyownofmi.org or (248) 649-3739 x 221.

Program Application

Applicant Name(Required)
MM slash DD slash YYYY
Applicant's Address(Required)
First Emergency Contact's Name(Required)
First Emergency Contact's Address(Required)
Second Emergency Contact's Address
Programs I'm interested in (select all that apply)(Required)
I affirm the applicant does not need 1:1 supervision(Required)
I affirm the applicant can independently manage their daily living activities (eating, using the restroom, hygiene)(Required)
I affirm the applicant has no history of aggression or harm to themselves or others in the last year(Required)
Pay $100 Application Fee