This application should be used if you are not sure if you qualify. Click here to see our basic requirements for residency. If you qualify, please move on to our full application rather than use the preliminary application. Click here for our full application.

Please fill out application and print
Then mail to :
Winifred Stuart Mankowski Homes   -   819 North Citrus Avenue, Azusa, CA 91702

Name Date  


City State
Telephone Number Age Citizenship
Marital Status    
Current Monthly Expenses

Current Monthly Income

Are you a member of The Mother Church? Yes No
Do you intend to continue active participation in a branch church? Yes No
Number of years listed in The Christian Science Journal?
Are you able to care for normal living needs without assistance (marketing, cooking, housekeeping)?
Yes No