29:11 Academy Housing Application

29:11 Academy Housing Application
We are now accepting housing applications in anticipation of starting to move residents in October 2025. After we receive your application, we will contact you with housing availability and rental rates. Even though this housing application is open to all individuals, this is a veteran priority property.

If you have any questions about the rental properties or the application process, please email kroberson@2911mentor.com or call 225.4061226.
Housing Eligibility*
In order to be considered as an eligible resident, you or another adult member of your household must complete the following information.
I am submitting this application to be considered for tenancy at the following property:
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Applicant's Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you a Veteran?
Veteran ID Number
Current Address

Street Address

Street Address Line 2

CityState

Zip Code
Current Landlord's Name
Phone #
How long at this address?
Reason for leaving
Previous Address

Street Address

Street Address Line 2

CityState

Zip Code
Previous Landlord's Name
Phone #
How long at this address?
Reason for leaving
Total number of members in your household?
Preferred Move-In Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

List the names, relations, and ages of all persons, including yourself, who will be living in the residence and are considered members of your household.

Rows	Name	Relation	Age
Applicant
Person 2
Person 3
Person 4

Specific Features Needed
Do you or any member of your household need any specific features, such as wheelchair accessibility, visual aids (Braille), or apparatus for hearing assistance?
If yes, please list the features needed:
Do you anticipate any additions to the household in the next 12 months?
If yes, please explain:
Will you or any member of your household require a live-in care attendant?

Do you have pets?

Employment Information
Are you currently employed?
Employer's Name
Position
Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How long at job?
Monthly Income

Rows	Care Attendant Name	Relation
Household Member

Any other source of Income?

Rows	Source of Income	Monthly Amount
Other Income
Other Income

Income and Asset Information
Combined income of all household members:
Value of all assets:
Income earned from assets:
Other Information
Are you or any member(s) of your household a full-time or part-time student?

Are you or any household member subject to any state sex offender registry?
Have you ever been convicted?
If yes to any of above two questions, please explain below:
Does the household have a tenant-based Housing Choice Voucher (a rental assistance voucher that travels with the Household) that will be used to subsidize rent?
If yes, list the issuing Housing Authority:
Head of Household Race and Ethnicity

The information regarding race and ethnicity is requested to assures the Federal Government that we do not discriminate on the basis of ethnic or race. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way.
Ethnic Categories (select one):
Racial Categories (select ALL that apply):

Other
Referral Source
Please indicate how you learned about the 29:11 Housing Program:

Other
Please indicate which paper, radio, etc. from above:
Certification
I/We certify that the housing for which this application is being submitted will be my/our only residence.
I/We understand that the above information is being collected to determine my/our eligibility.
I/We understand that the property owner will screen my household in accordance with the property's Resident Selection Plan and that submitting this application is not a guarantee that my household meets the criteria.
I/We understand that if my application is accepted, a non-refundable application fee of $50 will be required.
I/We understand that consumer reports and background checks, which may contain public record information, may be requested to evaluate our rental application.
I/We certify that the statements in this application are true and complete to the best of my/our knowledge. We understand that any false information is punishable by law and could be grounds for denial or this application or termination of residency after occupancy.
I/We understand that the information provided in this application will be verified by the owner.
Applicant's Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Rows	Pet Name	Breed	Age	Weight
Pet #1
Pet #2

29:11 Academy Housing Application

Housing Eligibility*

Specific Features Needed

Employment Information

Income and Asset Information

Other Information

Head of Household Race and Ethnicity

Referral Source

Certification