Affordable Housing Waitlist

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THE ROYAL BELMONT
WAITING LIST APPLICATION
Name _____________________________________________Home Tel. # ________________________
Address___________________________________________ Work Tel. #_________________________
City _____________________________________________State ___________ Zip _________________
Email (if available) _____________________________________________________________________
Unit size(s) for which you are applying (please circle):
Studio
1-Bedroom
2-Bedroom
3-Bedroom
HOUSEHOLD MEMBERS:
Please list ALL household members who will occupy the affordable apartment:
Name
Date of Birth
Sex
SS#
Relationship
HOUSEHOLD TYPE
Type A
6 person household: all types
5 person household: all types
4 person household: all types
3 person household: 1 head-of-household plus 2 dependents
3 person household: 2 heads-of-household plus one dependent, where heads of household cannot be required to
share a bedroom as a consequence of sharing would be a severe adverse impact on his or her mental or physical health
Type B
3 person household: 2 heads-of-household plus 1 dependent
2 person household: 2 heads-of-household who cannot be required to share a bedroom as a consequence of sharing
would be a severe adverse impact on his or her mental or physical health
2 person household: 1 head-of-household plus one dependent
Type C
2 person household: 2 heads-of-household
1 person household: all types
1

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