Housing Application
General Information
Please upload copies of the following for all household members: Photo ID (adult members 18 and over), Social Security Card, Birth Certificates, Proof of Income for all members, and six (6) consecutive paystubs, award letters from source, and W2 forms. APPLICATIONS SUBMITTED WITHOUT THESE DOCUMENTS WILL NOT BE ACCEPTED
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Location Preference
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Please Select
Apartments at Whitehall
Bridgeview Manor
Centralia Manor
Centurion Commons
Harrison Hi-Rise
Meadows at Forest Glen
Patton Square
Penn-Way Apartments
Rivermont Senior Apartments
Scattered Sites North (Sewickley to Oakmont)
Scattered Sites South (West Mifflin to Bethel Park)
Scattered Sites East (Monroeville to North Versailles)
Scattered Sites West (Mt. Lebanon to McKees Rocks)
St. Brendan's Apartments
West Deer Manor
West Pine Apartments
Name
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First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Daytime Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Evening Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Number of Bedrooms in Current Unit
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Do you rent or own?
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Rent
Own
How much is your current rental or mortgage payment?
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If owned, do you receive monthly rental income from property?
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Yes
No
Check utilities paid by you
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Heat
Electricity
Gas
Other
Approximate monthly cost of utilities paid by you (excluding phone and cable TV)
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Bedroom size requested (Select all that apply)
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Studio
1 Bedroom
2 Bedroom
3 Bedroom
Handicap Bedroom
Do you have a Section 8 or any other type of voucher?
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Yes
No
Do you currently own a pet?
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Yes
No
If yes, do you plan on moving the pet in to the apartment? List the type of pet.
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Household Composition
List ALL persons who will live in the apartment. List the head of household first.
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Rows
Name
Relationship to Head
Marital Status
Birth Date
Age
SSN
Student?
Head
M-Married
D-Divorced
S-Single
L-Legal Separation
E-Estranged
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Yes
No
Co-T
M-Married
D-Divorced
S-Single
L-Legal Separation
E-Estranged
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No
3.
M-Married
D-Divorced
S-Single
L-Legal Separation
E-Estranged
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Yes
No
4.
M-Married
D-Divorced
S-Single
L-Legal Separation
E-Estranged
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Yes
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M-Married
D-Divorced
S-Single
L-Legal Separation
E-Estranged
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Yes
No
6.
M-Married
D-Divorced
S-Single
L-Legal Separation
E-Estranged
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Yes
No
Do you anticipate any additions to the household in the next twelve months?
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Yes
No
If yes, explain.
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Will all of the persons in the household be or have been full-time students during five calendar months of this year or plan to be in the next calendar year at an educational institution (other than a correspondence school) with regular faculty and students?
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Yes
No
Are any full-time student(s) married and filing a joint tax return?
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Yes
No
Are any student(s) enrolled in a job-training program receiving assistance under the Job Training Partnership Act?
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Yes
No
Are any full-time student(s) a TANF or a title IV recipient?
*
Yes
No
Are any full-time student(s) a single parent living with his/her minor child who is not a dependent on another’s tax return?
*
Yes
No
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Income
List ALL sources of income as requested below. If a section doesn’t apply, type NA.
*
Rows
Household Member Name
Gross Monthly Amount
Social Security
Social Security
SSI Benefits
Pension (List Source)
Veteran’s Benefits (List Claim #)
Employment Income
Unemployment Compensation
Title IV/TANF
Full-Time Student Income (18 & Over Only)
Interest Income (Source: Bank, Annuity, CD, etc)
Do you own any property?
*
Yes
No
Type of Property
*
Location of Property
*
Appraised Market Value
*
Mortgage or Outstanding Loans Balance Due
*
Amount of Annual Insurance Premium
*
Amount of Most Recent Tax Bill
*
Have you sold/disposed of any property in the last 2 years?
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Yes
No
Type of Property
*
Market Value when Sold/Disposed
*
Amount Sold/Disposed For
*
Date of Transaction
*
-
Month
-
Day
Year
Date
Sources of Income
*
Are you entitled to receive alimony?
*
Yes
No
If yes, please list the amount you are entitled to receive.
*
Do you receive alimony?
*
Yes
No
If yes, list the amount you receive.
*
Are you entitled to receive child support?
*
Yes
No
If yes, please list the amount you are entitled to receive.
*
Do you receive child support?
*
Yes
No
If yes, please list the amount you receive.
*
Please list any other income amounts.
*
Total Gross Annual Income (Based on the monthly amounts listed above x 12)
*
Total Gross Annual Income from Previous Year
*
Do you anticipate any changes in this income in the next 12 months?
*
Yes
No
If yes, explain:
*
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Assets
Assets
*
If a Savings Bond was selected above, please provide the maturity date.
*
-
Month
-
Day
Year
Date
Life Insurance
*
Investments
*
Investment Property
*
Appraised Value
*
Have you disposed of any other assets in the last 2 years (Example: Given away money to relatives, set upIrrevocable Trust Accounts)?
*
Yes
No
If yes, describe the asset. Please include the date of disposition and the amount disposed.
*
Do you have any other assets not listed above (excluding personal property)?
*
Yes
No
If yes, please list.
*
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Additional Information
Are you or any member of your family currently using an illegal substance?
*
Yes
No
Have you or any member of your family ever been convicted of a felony?
*
Yes
No
If yes, please describe
*
Have you or any member of your family ever been evicted from any housing?
*
Yes
No
If yes, please describe
*
Have you ever filed for bankruptcy?
*
Yes
No
If yes, please describe
*
Will you take an apartment when one is available?
*
Yes
No
Briefly describe your reasons for applying
*
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Reference Information
Current Landlord
*
Prior Landlord
*
Credit Reference #1
*
Credit Reference #2
*
Personal Reference #1
*
Personal Reference #2
*
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Vehicle and Pet Information (if applicable)
Configurable list
*
Do you own any pets?
*
Yes
No
If yes, please describe
*
Signature of Tenant
*
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Signature of Co-Tenant (if applicable)
Signature of Co-Tenant (if applicable)
Signature of Co-Tenant (if applicable)
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