4111 Kansas Ave. NW

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Image Field
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Image Field
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Image Field
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Applicant Name* This field is required.
First Name
Last Name
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Applicant Date of Birth* This field is required.
Date
Month
Day
Year
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Applicant Phone Number* This field is required.Please enter your phone number. If you do not have a phone number, please enter someone else's number so we may contact you.
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Applicant EmailPlease enter your email address. If you do not have an email address, please provide an email address for someone you know so we may contact you. We will ONLY be contacting individuals via email, so please make sure this is a valid email address.
example@example.com
Confirm Email
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Is someone assisting you with filling out this form?* This field is required.
YESNO
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If someone is assisting you, what is their name?* This field is required.
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If someone is assisting you, please provide their phone number:* This field is required.
Area Code
Phone Number
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If someone is assisting you, please enter their email address:* This field is required.
example@example.com
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Do you have a portable housing voucher (LSRP, HCVP, VASH, etc.)?* This field is required.
YESNO
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If yes, What type of voucher do you have?
LRSP
HCVP
VASH
TAH
PSH
I don't know
I do not have a voucher
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If you do have a voucher, by selecting yes, you are acknowledging that you will be required to submit a copy of your voucher.
YESNO
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If you do not have a voucher: Please note, the rent for a one-bedroom apartment at this property starts at $2467 and the rent for a two-bedroom apartment starts at $2872. By selecting yes, you certify that you understand you will be responsible for the full rental amount.
YESNO
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Do you currently have income?* This field is required.
YESNO
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What are your sources of income?* This field is required.Check all that apply
SSI
Social Security Disability Income
IDA
Child Support
Alimony
Veteran Benefits
Part-Time Employment
Full-Time Employment
Unemployment Benefits
I do not have income
Other
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What is your current gross (before taxes) monthly income?* This field is required.
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If you are employed, what is the name of your employer?If you are not currently employed, please enter NA.
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If you are currently employed, how long have you worked at your job?If you are not currently employed, please enter NA.
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If you are currently employed, how many hours per week do you work?
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If you are currently employed, what is your hourly rate? If you are salaried, please list your annual salary.
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Do you have a history of drug or alcohol abuse?* This field is required.
YESNO
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If you have a history of drug or alcohol abuse, do you have 6 months of documented clean time from drugs AND alcohol that you can produce?* This field is required.
Yes
I have not yet reached 6 months of documented clean time from drugs and alcohol
I do not have a history of drug or alcohol abuse
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Do you have a recent history of violent behavior within the past year?* This field is required.
YESNO
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How did you hear about this opportunity?* This field is required.
Family/Friend
Facebook
Twitter
LinkedIn
Instagram
SOME's Website
SOME Housing Flyer
SOME Employee
Other
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Which unit size are you applying for?* This field is required.
One-Bedroom
Two-Bedroom
Other
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On a separate line for each, please list the full name, age, and relationship to you of each individual who will be residing in the apartment.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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* This field is required.As a part of residency with SOME Single Adult Housing, your eligibility may be determined based upon the information provided in this form, but please be aware there may be additional requirements. Please type your name below to certify that you have read and understood the above information.
First Name
Last Name
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Please upload copies of the following documents listed below to complete your application.- Driver's License and/or Identification Card (Adults 18+) - Birth Certificates (All Household Members) - Social Security Card (All Household Members) - Proof of Income (SSI, TANF, IDA, Child Support, Unemployment, Benefits Statement must be less than 90 days old, Employment Offer Letter, 9 consecutive Paystubs, etc.) - Portable Housing Voucher
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SignatureI certify that the information I provided in this form is, to the best of my knowledge, accurate. By signing, I certify that I understand that only those who have been selected in the lottery will receive a phone call at the phone number they provided. Those who have not been selected will be contacted via the email address provided.
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