Rental Application - Usda/hud Properties Only Page 2
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10USDA/HUD HOUSING APPLICATION
Date Received: ______________________
Time Received: ________
(Management use only)
Applying for: __________________________________________________________________ mention town(s)
APPLICANT INFORMATION:
Name: _____________________________________________________________________________
Last First Middle Initial
Current Address: ____________________________________________________________________
Street City State Zip Code
Telephone #: ____________________ SS#: _____________________ Date of Birth: _____________
HOUSEHOLD INFORMATION:
List below information for each additional household member who will occupy the unit.
Name
Relationship to
Social Security
Date of Birth
(First, Middle Initial, Last)
Head of Household
M/F
Number
(Mo./Day/Yr.)
M F
M F
M F
M F
M F
M F
Marital Status: Married Separated
Divorced Unmarried
Do you anticipate a change in household composition during the next 12 months? Yes No
Will any of the above household members live anywhere except in the apartment? Yes No
Will any other persons live in the apartment on a less than full‐time basis? Yes No
If you answered “Yes to either questions, please explain_________________________________________
Does the household require any special accommodations? If yes, please explain:______________________
Are any household members a full‐time or part‐time student at an institute of higher learning? If yes, please
list school you/they are attending:___________________________________________________________
How did you hear about our apartments?
___
MISCELLANEOUS INFORMATION:
Are you or any household member currently expecting a child? Yes No
If yes, what is the scheduled due date: ______________________
Have you or any other adult members ever used any name(s) (maiden last name or other) or Social Security
number(s) other than the one you are currently using? Yes No If yes, explain: ____________________
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