PRELIMINARY APPLICATION FOR HOUSING
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Step
1
of 5
Date
*
Apartment Type
*
Select Please
One Bedroom
Two Bedroom
1. List each person in your household starting with yourself. Information will be added to the property's waiting list. Incomplete applications will not be processed.
Member Number 1
Name
*
Birth Date
*
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Select Sex
*
Male
Female
Other
Relationship
*
Select One
Head
Husband
Wife
Son
Daughter
Mother
Father
Aunt
Uncle
Grandmother
Grandfather
Grandson
Granddaughter
Annual Income
*
Example: $20,000
Social Security Number
*
Example:123-456-6789
Student Status (For PIT)
Member Number 2
Name
Birth Date
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Select Sex
Male
Female
Other
Relationship
Select One
Head
Husband
Wife
Son
Daughter
Mother
Father
Aunt
Uncle
Grandmother
Grandfather
Grandson
Granddaughter
Annual Income
Social Security Number
Student Status (For PIT)
Next
Member Number 3
Name
Birth Date
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YYYY
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2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
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2008
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2006
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2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Select Sex
Male
Female
Other
Relationship
Select One
Head
Husband
Wife
Son
Daughter
Mother
Father
Aunt
Uncle
Grandmother
Grandfather
Grandson
Granddaughter
Annual Income
Social Security Number
Student Status (For PIT)
Member Number 4
Name
Birth Date
MM
1
2
3
4
5
6
7
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9
10
11
12
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DD
1
2
3
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5
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30
31
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YYYY
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Select Sex
Male
Female
Other
Relationship
Select One
Head
Husband
Wife
Son
Daughter
Mother
Father
Aunt
Uncle
Grandmother
Grandfather
Grandson
Granddaughter
Annual Income
Student Status (For PIT)
Social Security Number
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Next
2. Does anyone live with you now who is not listed in Step 1 or 2?
*
Yes
No
If you answered yes to question number 2 please explain:
*
3. Do you expect any change in your household composition?
*
Yes
No
If you answered yes to question number 3 please explain:
*
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Next
4. What type of income do you have?
*
Select One
Employment
Social Security
SSI Welfare
Unemployment
Child Support
Other
5. Are you a US Citizen?
*
Yes
No
6. Your Current Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Email
*
7. Do you have any special housing needs that may be required by you or any of the members in your household:
*
Yes
No
If you answered yes to question number 7 please explain:
*
8. Are you currently residing in subsidized housing or do you have a Section 8 voucher?
*
Yes
No
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CERTIFICATION
We hereby certify that I/We do/will not maintain a separate subsidized rental unit in another location. I/We further certify that this will be my/our permanent residence. I/We understand I/We must pay a security deposit for the apartment prior to occupancy. I/We understand that our eligibility for housing will be based on applicable income limits and by management's selection criteria. I/We certify that all information in this application is true to the best of my/our knowledge and I/We understand that false statements or information are punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy. VWe further consent to have the Owner/Management Agent verify all of the information contained in this Rental Application as well as my/our credit, landlord, criminal background and personal references. Any changes in family household income or student status changes are required to be reported to the management office within 10 days of the change. All adult applicants, 18 or older, are required to sign application.
Signature of Tenant
*
Clear Signature
Date
*
Comment
Submit
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