Reference Sheet

Reference Sheet
Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Forms Due Date

MonthDayYear
Date
APPLICANT INFORMATION
Full Name:*

First NameLast Name
Do you have a middle name?*

YesNo
Middle Name:*
Middle Name
Social Security Number:*
Birth Date:*
Marital Status:*

SingleMarriedDivorcedSeparatedOther
Gender:*

MaleFemale
Address where you are LIVING right now*

Street Address

Apt/Unit Number

CityState

Zip Code
Address where you RECEIVE MAIL today*

Street Address

Apt/Unit Number

CityState

Zip Code
Do you have a cell phone?*

YesNo
Cell Phone Number:*
Please enter a valid phone number.
Do you have a home phone (landline)?*

YesNo
Home Phone Number:*
Please enter a valid phone number.
Do you have an email address?*

YesNo
Email Address:*
example@example.com
EVICTION DISCLOSURE
Has the applicant ever been evicted?*

YesNo
CO-APPLICANT INFORMATION
Did you have a co-applicant on your applicant? (Spouse, Significant Other, Another Adult Household Member)*

YesNo
Full Name:*

First NameLast Name
Does the Co-Applicant have a middle name?*

YesNo
Co-Applicant's Middle Name:*
Middle Name
Co-Applicant's Gender:*

MaleFemale
Co-Applicant's Birth Date:*
Co-Applicant's Social Security Number:*
Does the Co-Applicant have a cell phone?*

YesNo
Co-Applicant's Cell Phone Number:*
Please enter a valid phone number.
Does the Co-Applicant have a home phone (landline)?*

YesNo
Co-Applicant's Home Phone Number:*
Please enter a valid phone number.
Does the Co-Applicant have an email address?*

YesNo
Co-Applicant's Email Address:*
example@example.com
PROFESSIONAL REFERENCES
We need 3 professional references. Family members or friends cannot be used as professional references. Examples of professional references include, but are not limited to current/past employers, supervisor, or managers, current/past coworkers, professors, advisors, etc.

Please provide a valid email address and/or fax number for EACH reference. A form will be emailed or faxed to each of your references you list to complete on your behalf with the email or fax number you provide. Be sure to double-check the email address to be sure it is current. If you do not list a valid email address and/or fax number, your references won't be able to complete the form, and you will be denied for insufficient references, and we will move on to the next person on the waiting list.

It is often helpful if you reach out to each of your references after you submit the form and ask them to watch for the email from our office and to complete the form that was emailed to them by the deadline. Remind them to check thei spam/junk folder. If they have not receive it within a day of you submitting the reference sheet, please contact Tammy at 218-637-2431 or at tammy@nwmnhra.org. If submitting the form in person the email will come from Tammy. If submitting the form online, the email will come from JotForm with Northwest Minnesota Multi-County HRA as the name and the subject line will be "Reference Form Completion". The form will be due by noon on {formsDue}. If we do not receive the form by the deadline, we will need to move to the next person on the waiting list.
Reference #1
Name:*
Phone Number:*
Please enter a valid phone number.
Relationship to Applicant:*

Current or Past EmployerProfessor, Academic Advisor, or TeacherCurrent or Past Supervisor or ManagerFinancial Advisor (Bank, Investment Agency, etc.)Current or Past CoworkerReligious Worker (Pastor, Priest, Reverend, etc.)Coach or MentorVolunteer OrganizationFamilyCurrent or Past LandlordFriendOther
Family members may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficient references.
Friends may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficienct references.
Current or past landlords may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficient references.
Email Address for Reference #1:*

Confirmation EmailMAKE SURE THE EMAIL IS CORRECT. AN INVALID EMAIL MAY DELAY OR DENY YOUR APPLICATION
Fax Number:
MAKE SURE THE NUMBER IS CORRECT. AN INVALID FAX NUMBER MAY DELAY OR DENY OR APPLICATION
My initials acknowledge that the email address and/or fax number above is valid.
Initials:*
Reference #2
Name:*
Phone Number:*
Please enter a valid phone number.
Relationship to Applicant:*

Current or Past EmployerProfessor, Academic Advisor, or TeacherCurrent or Past Supervisor or ManagerFinancial Advisor (Bank, Investment Agency, etc.)Current or Past CoworkerReligious Worker (Pastor, Priest, Reverend, etc.)Coach or MentorVolunteer OrganizationFamilyCurrent or Past LandlordFriendOther
Family members may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficient references.
Friends may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficient references.
Current or past landlords may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficient references.
Email Address for Reference #2:*

Confirmation EmailMAKE SURE THE EMAIL IS CORRECT. AN INVAILD EMAIL MAY DELAY OR DENY YOUR APPLCATION
Fax Number:
MAKE SURE THE NUMBER IS CORRECT. AN INVAILD FAX NUMBER MAY DELAY OR DENY YOUR APPLICATION
My initials acknowledge that the email address and/or fax number above is valid.
Initials:*
Reference #3
Name:*
Phone Number:*
Please enter a valid phone number.
Relationship to Applicant:*

Current or Past EmployerProfessor, Academic Advisor, or TeacherCurrent or Past Supervisor or ManagerFinancial Advisor (Bank, Investment Agency, etc.)Current or Past CoworkerReligious Worker (Pastor, Priest, Reverend, etc.)Coach or MentorVolunteer OrganizationFamilyCurrent or Past LandlordFriendOther
Family members may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficient references.
Friends may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficient references.
Current or past landlords may not be used as professional references. Only professional references are accepted.

If you do not use a professional references, your application may be delayed or denied due to insufficient references.
Email Address for Reference #3:*

Confirmation EmailMAKE SURE THE EMAIL IS CORRECT. AN INVALID EMAIL MAY DELAY OR DENY YOUR APPLICATION
Fax Number:
MAKE SURE THE NUMBER IS CORRECT. AN INVALID FAX NUMBER MAY DELAY OR DENY YOUR APPLCATION
My initials acknowledge that the email address and/or fax number above is valid.
Initials:*
RESIDENCY HISTORY/LANDLORD INFORMATION
You must provide at least the last 5 years of where you have lived.

Please provide a valid email address and/or fax number for EACH landlord. A form will be emailed or faxed to each of your landlords you list to complete on your behalf with the email or fax number you provide. Be sure to double-check the email address to be sure it is current. If you do not list a valid email address and/or fax number, your landlords won't be able to complete this form.

It is often helpful if you reach out to each of your landlords after you submit the form and ask them to watch for the email from our office and to complete the form that was emailed to them by the deadline. Remind them to check their spam/junk folder. If they have not received it within a day of you submitting the reference sheet, please contact Tammy at 218-637-2431 or at tammy@nwmnhra.org. If submitting the form in person, the email will come from Tammy. If submitting the form online, the email will come from JotForm with Northwest Minnesota Multi-County HRA as the name and the subject line will be "Landlord Verification Form Completion". The form will be due by noon on {formsDue}. If we do not receive the form by the deadline, we will need to move to the next person on the waiting list.
Select One:*

I have lived with my parents my whole lifeI have lived on my own in either a rental or bought a home
Current Address*

Street

Apartment/Unit/Lot

CityState

Zip
Living Status:*

OwnRentParentsOther
Phone Number for Parent/Other:*
Please enter a valid phone number.
Is your name on the lease?*

YesNo
Do you have a payment?*

YesNo
Monthly Payment:*
Are utilities included?*

YesNo
Dates you have lived at this address. From: MM/YYYY* to MM/YYYY*.

Example: If you moved here in August 2018 and currently live here, you would enter: "08/2018" in the first blank and "Current" in the second blank.
Reason for Moving:*
Current Landlord's Name:*
Current Landlord's Email Address:*

Confirmation Emailexample@example.com
Current Landlord's Phone Number:*
Please enter a valid phone number.
Current Landlord's Fax Number:
Please enter a valid phone number.
Do you have previous addresses that you can provide?*

YesNo
How many?*

12
Previous Address:*

Street

Apartment/Unit/Lot

CityState

Zip
Living status at this address:*

OwnRentParentsOther
Phone Number for Parent/Other:*
Please enter a valid phone number.
Was your name on the lease?*

YesNo
Did you have a monthly payments?*

YesNo
What was your monthly payment?*
Were utilities included?*

YesNo
Dates you lived at this address. From: MM/YYYY* to MM/YYYY*

Example: If you moved here in November 2016 and moved out in August 2018, you would enter: "11/2016" in the first blank and "08/2018" in the second blank.
Reason for Moving:*
Previous Landlord's Name:*
Previous Landlord's Email Address (1):*

Confirmation Emailexample@example.com
Previous Landlord's Phone Number:
Please enter a valid phone number.
Previous Landlord's Fax Number:
Please enter a valid phone number.
Previous Address:*

Street

Apartment/Unit/Lot

CityState

Zip
Living status at this address:*

OwnRentParentsOther
Phone Number for Parent/Other*
Please enter a valid phone number.
Was your name on the lease?*

YesNo
Did you have a monthly payment?*

YesNo
What was your monthly payment?*
Were utilities included?*

YesNo
Dates you lived at this address. From: MM/YYYY*to MM/YYYY*

Example: If you moved here in March 2015 and moved out in October 2016, you would enter: 03/2015 in the first blank and 10/2016 in the second blank.
Reason for Moving:*
Previous Landlord's Name:*
Previous Landlord's Email Address:*

Confirmation Emailexample@example.com
Previous Landlord's Phone Number:
Please enter a valid phone number.
Previous Landlord's Fax Number:
Please enter a valid phone number.
I, the undersigned, do hereby give Northwest Minnesota Multi-County HRA permission to do a reference, credit, and criminal background check for the purpose of renting from Northwest Minnesota Multi-County HRA. I understand I have the right to withdraw this permission at anytime.

I certify that the email addresses and/or fax numbers I have entered for my references and/or current and previous landlords is valid. I understand that if I did not give a valid email address or fax number, my references and/or landlord will not be able to complete the reference verification on my behalf. I understand this will result in me being denied due to insufficient references.
Applicant's Printed Name:*
Today's Date:*

MonthDayYear
Date
Applicant's Signature:*

Clear
Is there a Co-Applicant listed on this form?*

YesNo
Co-Applicant's Printed Name:*
Today's Date:*

MonthDayYear
Date
Co-Applicant's Signature:*

Clear
Should be Empty:

Reference Sheet

APPLICANT INFORMATION

EVICTION DISCLOSURE

CO-APPLICANT INFORMATION

PROFESSIONAL REFERENCES

Reference #1

Reference #2

Reference #3

RESIDENCY HISTORY/LANDLORD INFORMATION