Wilson Villa Wait List Application

Wilson Villa
Completed Applications to be sent to Management Agent;
Sage Management Corporation of Western New York
916 Upper Mountain Road, Lewiston, NY 14092
Phone: 716-298-4966 Fax: 716-298-4489
www.sagemanagementcorp.com
Wilson Villa Building A
240 Autumnview Drive
Wilson NY 14172
12 One Bedroom Apartments
Wilson Villa Building B
240 Autumnview Drive
Wilson NY 14172
12 Two Bedroom Apartments

To Qualify You Must

· Meet Screening Criteria Listed In Tenant Selection Plan. (Found Here)

· Meet the income qualifications listed below.

Income Level	1 Person	2 Persons	3 Persons
Very Low	$21,250	$24,250	$27,300
Low	$35,350	$40,400	$45,450

Priority is given to those applicants with very low income.

Income Levels Updated: April 1 2025

Please check below to acknowledge you have read the above.

Please check below to acknowledge you have read the above.

Please check below to acknowledge you have read the above.

Please check below to acknowledge you have read the above.

Head Of Household
Name

First NameLast Name
Social Security #
Date Of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Driver's License /State ID #
State Issued
Race
Gender
Ethnicity
The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.

This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.

Please List All Other Household Memebers
If you have more than one person in the household. You must provide all their infomation for the application to be complete. Press the arrow on the right side to drop down the required infomation. If you do not have any other household members, select Next on the bottom of the page. If you do not have the infomation, you can save the application and complete at a later date.
- Name
  
  First NameLast Name
- Social Security #
- Date Of Birth
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Race
- Gender
- Ethnicity
- The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.
  
  This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.
- Name
  
  First NameLast Name
- Social Security #
- Date Of Birth
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Race
- Gender
- Ethnicity
- The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.
  
  This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.
- Name
  
  First NameLast Name
- Social Security #
- Date Of Birth
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Race
- Gender
- Ethnicity
- The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.
  
  This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.
- Name
  
  First NameLast Name
- Social Security #
- Date Of Birth
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Race
- Gender
- Ethnicity
- The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.
  
  This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.
- Name:   First Name   Last Name
  Date of Birth:   Date Of Birth
  Social Security No:   SSN#
  Phone:   Area Code   Phone Number
  Email:   Email
  Address:    Street Address   Address Line 2   City   State   Zip
  License Information:     License #   State
  Race:
  Gender:
  Ethnicity:
  ----------------------------------------------------------------------------------------
- Name:   First Name   Last Name
  Date of Birth:   Date Of Birth
  Social Security No:   SSN#
  Phone:   Area Code   Phone Number
  Email:   Email
  Address:    Street Address   Address Line 2   City   State   Zip
  License Information:     License #   State
  Race:
  Gender:
  Ethnicity:
  ----------------------------------------------------------------------------------------
- Name:   First Name   Last Name
  Date of Birth:   Date Of Birth
  Social Security No:   SSN#
  Phone:   Area Code   Phone Number
  Email:   Email
  Address:    Street Address   Address Line 2   City   State   Zip
  License Information:     License #   State
  Race:
  Gender:
  Ethnicity:
  ----------------------------------------------------------------------------------------
- Name:   First Name   Last Name
  Date of Birth:   Date Of Birth
  Social Security No:   SSN#
  Phone:   Area Code   Phone Number
  Email:   Email
  Address:    Street Address   Address Line 2   City   State   Zip
  License Information:     License #   State
  Race:
  Gender:
  Ethnicity:
  ----------------------------------------------------------------------------------------

Other Household Information
Do you Have a Pet?

If yes, please provide pet information

Rows	Species	Weight	Color
Animal

If yes, please provide documentation of any required licenses and required shots.

Cancelof
Do you have a vehicle?

If yes, please provide vehicle information.

Rows	Year	Make	Model	Color	License Plate #	State Issued
Vehicle

RELEASE OF INFORMATION AUTHORIZATION
I do hereby authorize Sage Management and any authorized representative to contact any agencies, offices, groups or organizations to obtain and verify any information or materials which are deemed necessary to complete my application for housing. This could include police/background checks and credit checks.
Head Of Household
Date

MonthDayYear
Date
Signature
Sage Management Corporation of Western New York & Wilson Villa do not discriminate on the basis of race. color, religion, sex, national origin, age, marital status, disability, handicap, sexual orientation, gender identity, or familial status.
Should be Empty:

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Wilson Villa

Wilson Villa Wait List Application

Special Unit Questionnarie

Head Of Household

Please List All Other Household Memebers

Other Household Information

Income

Assets

Declaration of No Assets

Medical Expenses

Justice Involvement Check

Landlord Reference

CERTIFICATION

RELEASE OF INFORMATION AUTHORIZATION

Rows	Name	Asset Type	Cash Value
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