Affordable Housing Program Application Form
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4For Office Use Only
Date Received: ________
Site Name: ______________________________
AFFORDABLE HOUSING PROGRAM APPLICATION FORM
A FALSE OR WILLFULLY OMITTED STATEMENT HEREIN WILL BE GROUNDS FOR CANCELLATION OF
YOUR APPLICATION.
PLEASE PRINT AND ANSWER ALL QUESTIONS
How did you learn about our apartments? Circle One.
Internet
Newspaper
Referral
Drove by
Other
(explain) ___________________________
1) APPLICANT INFORMATION
NAME:
HOME PHONE:
CELL PHONE:
SS#:
DATE OF BIRTH:
E-MAIL ADDRESS
CURRENT ADDRESS:
CITY
STATE
ZIP
HOW LONG:
PREVIOUS ADDRESS:
CITY
STATE
ZIP
HOW LONG:
2) OTHER OCCUPANTS - List below the names of all other persons (in addition to “APPLICANT” above to occupy
apartment). Occupancy is limited to people listed.
FULL NAME
RELATIONSHIP
SOCIAL SEC. #
DOB
REMARKS
mm/dd/yyyy
3) CURRENT LANDLORD/MORTGAGE INFORMATION
PRINT NAME:
PHONE #:
ADDRESS:
FAX #:
RENTAL DATES
FROM:
TO:
MONTHLY RENT AMOUNT:
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