Mountain Homeless Coalition Rental Application

Mountain Homeless Coalition Rental Application
For shared housing and/or Georgia Street Cabins and/or Emergency Housing Vouchers

For inquiries about other rental properties, please contact Mountain Homeless Coalition at: Email Address: PropMgt@mtnhomeless.com or Phone: (909) 713-4099
I am applying for

Georgia St. Cabins, Big Bear Lake Shared Housing EHV Other
APPLICANT'S PERSONAL INFORMATION
Name *
Email Address
example@example.com
Date of Birth *

Month Day Year
Date
Cell Phone
Other Phone & Type
Soc Sec # *
Driver’s Lic # and State
Current housing situation
Desired move in date *

Month Day Year
Date
CO-APPLICANT’S PERSONAL INFORMATION (if applicable)
Name
Email Address
example@example.com
Date of Birth

Month Day Year
Date
Cell Phone
Other Phone & Type
Soc Sec #
Driver’s Lic # and State
Current housing situation
OTHER OCCUPANTS’ INFORMATION (if applicable)
Name
Email Address
example@example.com
Date of Birth

Month Day Year
Date
Name
Email Address
example@example.com
Date of Birth

Month Day Year
Date

Pets:

	Name	Type (dog, cat, ...)	Breed	Weight	Age
Pet 1
Pet 2

PROOF OF INCOME

The applicant is required to provide proof of their income. Acceptable documentation includes bank statements, pay stubs, determination letters, or screen shots of account balances.

Type a question

Personal References

	In case of emergency, Notify	Relationship	Phone/email

Please indicate your answer for the following questions:
Are you currently homeless?
Are you currently at risk of becoming homelessness?
Do you or any member of your household require a reasonable accommodation?
Do you or any member of your household require unit accessibility features?
If you answered to any of the above, please add addition information:
I/We declare that the information I/we have provided is true and correct, and contain no misrepresentations.
I/We authorize Mountain Homeless Coalition (MHC) to conduct background checks and obtain credit reports, as necessary, from a reputable credit reporting agency to verify the information I/we have supplied. The Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing or may result in the denial of application. *
Applicant's Signature
Date *

Month Day Year
Date
Co-Applicant's Signature
Co-Applicant's Signature
Date

Month Day Year
Date
Reasonable Accommodation: If you or a member of your family have a disability and think that you might need or want a reasonable accommodation, you may request it at any time.
Should be Empty: