Snow Belt Housing
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Street Address Line 2
Postal / Zip Code
Names of all household members that contribute to income:
Source of income for each household member:
Total monthly income for each tenant:
What is the total yearly income for everyone in the household?
How many people live in the household?
Is anyone age 60 or over?
Is anyone disabled?
Is anyone handicapped?
Are you currently receiving housing assistance?
Are you currently on the waiting list for one of our properties?
Are you current with your utility companies?
Has anyone in the household been convicted of a felony?
Has anyone in the household been convicted of any drug charges?
Does anyone in the household smoke?
Do you have any pets?
Type of apartment desired:
Number of bedrooms?
Upper or lower unit?
Amount of rent you can afford?
Do you need a handicap accessible unit?
Should be Empty:
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