AMAT Group Homes | Premier Licensed Adult Residential Care in North Carolina

NC DHHS Licensed Residential Care Intake

Apply for Residency at AMAT Group Homes

Complete our two-step residency placement application below. Your progress is automatically saved to our database as you type, and an automated confirmation email will be sent immediately upon submission.

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Section 1

Submitter Role

I am completing this form as the: *

The ApplicantA Legal Guardian or Family MemberA Case Manager or Social WorkerA Hospital Discharge Planner

Your Email Address (For Automated Confirmation Receipt) *

Your Direct Phone Number *

Section 2

Applicant Identity & Legal Status

Applicant Full Name *

Applicant Date of Birth *

Current Living Situation *

Does the applicant have a legally appointed guardian? *

YesNoPower of Attorney (POA)

Section 3

Program & Funding (North Carolina Specifics)

Which AMAT program are you applying for? *

Primary Funding / Payer Source *

Assigned NC LME/MCO (if applicable) *

Assigned Case Manager / Care Coordinator Name

Assigned Case Manager / Care Coordinator Email