Live in Oak Park Client Registration Form

Client Registration Form

Thank you for your interest in Live in Oak Park's apartment referral service!

We have moved our registration form to a new page.

Please visit https://form.jotform.com/OPRHC/2022-client-registration-form to complete your Client Registration Form and receive available apartment listings.
Your Name*

First NameLast Name
Your Current CITY of Residence*
State or Other Continent/Country*
Zip Code*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*

Area CodePhone Number
Email*
example@example.com
YEARLY Total Combined Household Income (Before Taxes)*
ADD THE INCOMES OF EACH ADULT IN THE HOUSEHOLD
30% of Total Monthly Household Income*
Anticipated Maximum Rent Budget*
This budget should be similar to or below the above 30% figure
Are you a full-time student and receiving rental assistance from loans and/or parental support?*

YesNo
Credit Score (if known)
If you do not know your exact credit score, please select your current credit rating*

GoodAveragePoorI'm not sureNo credit score established
When is the absolute earliest date you can move?*

MonthDayYear
Date
When is the absolute latest date you can move?*

MonthDayYear
Date
Total Persons (Including Children) to Occupy Apartment*
Bedrooms Needed*
Do you require pet friendly listings?*

Yes, allows catsYes, allows dogsNo
If you said "Yes, allows dogs", please specify the weight of dog. Otherwise, please answer "None".*
Any special requirements? (For example: Near the Blue Line, Top Floor, Hardwood, etc.)

This is your chance to let us know what you need in your apartment!0/200
How did you learn about us?*

Apartments.comCraigslistZillowInstagramFriend/FamilyFacebookPrevious ClientTwitterWalk ByOther
Are you using a Housing Choice Voucher?*

YesNo
If yes, which Housing Authority provided the Voucher?
The information on this intake form will remain confidential. However, it is vital funding/grant information required for reporting in aggregate to HUD and all content on this page is required by HUD. Please complete below:
Are you a female head of household (the member of the family who has been designated by the family as the head for purposes of determining income eligibility and rent)?*

YesNo
Are you (or another household Adult) of Hispanic / Latinx ethnicity?*

YesNo
Are you (or another household Adult) of Arab or Middle Eastern ethnicity?*

YesNo

Racial Identity: Please Indicate the Race(s) of Adults in the Household. Check all that apply.*

	You	2nd Adult	3rd Adult
White A person having origins in any of the original people of Europe, the Middle East or North Africa
Black / African American A person having origins in any of the black racial groups in Africa or the Caribbean
Asian A person with origins in any of the peoples of the Far East, Southeast Asia or the Indian subcontinent including for example: Afghanistan, Bangladesh, Cambodia, China, India, Japan, Korea, Laos, Malaysia, Mongolia, Pakistan, Philippine Islands, Thailand and Vietnam
American Indian / Alaskan Native A person having origins in North, Central or South America who maintains a tribal community attachment (not just claim of ancestry)
Native Hawaiian / Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands
American Indian or Alaska Native AND White
Asian AND White
Black / African American AND White
American Indian / Alaska Native AND Black / African American

Please Indicate the Race(s) of Adults in the Household. Check all that apply.*

	You	2nd Adult	3rd Adult
White A person having origins in any of the original people of Europe, the Middle East or North Africa
Black / African American A person having origins in any of the black racial groups in Africa or the Caribbean
Asian A person with origins in any of the peoples of the Far East, Southeast Asia or the Indian subcontinent including for example: Afghanistan, Bangladesh, Cambodia, China, India, Japan, Korea, Laos, Malaysia, Mongolia, Pakistan, Philippine Islands, Thailand and Vietnam
American Indian / Alaskan Native A person having origins in North, Central or South America who maintains a tribal community attachment (not just claim of ancestry)
Native Hawaiian / Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands
American Indian or Alaska Native AND White
Asian AND White
Black / African American AND White
American Indian / Alaska Native AND Black / African American

Your signature below indicates that you accept disclosure of your new address (or nearest cross streets) as terms of agreement for our service.
Draw your signature using your mouse or finger / stylus if you are using a touchscreen device.
Signature*

Clear
Certification: I certify that the information on this registration form is true and correct as of the date with my signature here and acknowledge my understanding that any intention or negligent misrepresentation(s) of the information contained on this form may result in civil liberty and or criminal penalties including, but not limited to, fine or imprisonment or both under the provision of Title 18, United States Code, section 1002, et seq.
Date*

MonthDayYear
Date
For Office Use Only: The following section is to be filled out by the Housing Center. Please do not answer any of the following questions.
ID #:       Advisor:       Admin / Public Service

G:      Date:      Time:

Final Result:      Date:

Close-Out Date:      Aff Move? Y / N

Listings:


30-Day Follow-Up Email:
Initials & Date

60-Day Follow-Up Call:
  Initials & Date

90-Day Follow-Up Call:
  Initials & Date
Should be Empty: