• Laurel Grove & Laurel Court

    Initial Screening Application
  • DATE OF BIRTH*
     / /
  • Format: (000) 000-0000.
  • Best Method of Contact*
  • For 'Other' Contact, may we leave a message?

  • ADDITIONAL HOUSEHOLD MEMBERS

    Please list the family members (if any) who will be living with you
  • Rows
  • Do you have a disability that qualifies you for residence at this subsidized unit?*
  • Format: (000) 000-0000.
  • Do you or a household member need an accessible unit?*
  • If yes, can you provide verification?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Rows
  • Are you currently living in subsidized housing?*
  • Have you ever been evicted from subsidized housing?*
  • If yes, what were your dates of residency?
     / /
  •  - -
  • Are you and all of your household members U.S. Citizens?*
  • Are you currently using or selling illegal drugs?*
  • If you drink alcoholic beverages, is there reason to believe that your consumption of alcohol will interfere with the health, safety, or peaceful enjoyment of the property by other tenants?*
  • Are you required to be registered with the State Sex Offender Registration program?*
  • The following preferences for priority services will be applied at the time housing is available. Please check ALL of the circumstances that presently apply to you, and notify us of any relevant changes.*

  • Laurel Grove and Laurel Court Apartments are smoke-free units. Smoking, vaping, or use of tobacco products is prohibited by you and/or your guests at all times while inside the units or any structures on the property. Smoking is only permitted in outside, designated areas at each property.

    After reading the following certification, please sign below to indicate you understand and agree to it:

     

    CERTIFICATION: The information provided on this pre-application form is complete and true to the best of my knowledge. I understand that providing false information may lead to denial of this application, to eviction (if falsehood is discovered after move-in), or to criminal prosecution. I understand that admission to this site is conditioned upon eligibility criteria by federal law, rules set by this site's tenant selection plan, and my payment of applicable security deposit in advance of move-in. I understand that, should I be accepted for admission, I must not maintain any other residence anywhere after move-in. I further understand that this information will be verified and that I MUST keep the application current by notifying Laurel Hill Center of changes in address and preferential status.

  • Date*
     / /
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  • Should be Empty: