Applicant Information

First Name
MI
Last Name
Phone
Email
Which community are you interested in?
What size unit?
Car Year/Make/Model
License Plate #
Second Car Year/Make/Model
License Plate #
Would you or a member of your household benefit from the design features of a barrier free unit?

Rental History

Current Address
City
State
ZIP
Move-In Date
Move-Out Date
Reason For Moving
Current Landlord
Landlord Phone/Address
Previous Address
City
State
ZIP
Move-In Date
Move-Out Date
Reason For Moving
Previous Landlord
Landlord Phone/Address

Occupants

Please list all persons that will occupy the residence. Occupant #1
First Name
MI
Last Name
Maiden Name
Date of Birth
SSN
Relationship
Occupant #2
First Name
MI
Last Name
Maiden Name
Date of Birth
SSN
Relationship
Occupant #3
First Name
MI
Last Name
Maiden Name
Date of Birth
SSN
Relationship
Occupant #4
First Name
MI
Last Name
Maiden Name
Date of Birth
SSN
Relationship

Employment

Employer Name
Address
Phone
Starting Date
Salary or Hourly Rate
Supervisor
Full/Part Time?
Average Hours/Week Worked

Other Income Sources

Please list household income from all other sources (i.e. Social Security, pension, child support, Section 8 certificate, etc.)
Income Source 1
Amount/mo 1
Income Source 2
Amount/mo 2
Income Source 3
Amount/mo 3
Do you or any member of your household engage in current illegal use or distribution of a controlled substance or have you previously been convicted of the same?
If you answered "yes" to the above question, have you successfully completed a controlled substance abuse program or are you presently enrolled in such a program?
If "yes", please explain:
Have you ever been convicted of a crime, felony, misdemeanor?
If "yes", please explain:
Have you disposed of any assets in the last 2 years?
If "yes", please list asset(s) and value received:
Are you a full-time student?
Are any members of your household full-time students?
Have you or any member of your household lived in assisted housing?
If "yes", when and where?
Have you ever commited fraud in an assisted housing program or been requested to repay money for knowingly misrepresenting information for such housing programs?
If "yes", please explain:

Personal References

List 3 relatives we can call for a personal reference Reference #1
Name
Phone
Relationship
Address
Reference #2
Name
Phone
Relationship
Address
Reference #3
Name
Phone
Relationship
Address