Rental Application Form

Rental Application Form

Apply for housing at your preferred property.
Rental Application #102522 KS36810
This is an application for housing at:
Project*
Address*
Please complete this application and return to:
Name*
Address*
Applications are placed in order of date and time received. An applicant may be interviewed only after the receipt of this tenant application. Every question must be answered. Do NOT leave blanks. Use N/A when not applicable.
Section A. GENERAL INFORMATION
Applicant Name*
Current Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / 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*
Do you RENT or OWN your current residence?*

RentOwn
Amount of current monthly rental or mortgage payment*
If owned, do you receive monthly rental income from property?*

YesNo
Check utilities paid by you*

HeatElectricityGasOther
Approximate monthly cost of utilities paid by you*
Bedroom size requested*

StudioOne BRTwo BRThree BRHandicap BR
B. HOUSEHOLD COMPOSITION
Explain custody agreement (proof of custody may be required)*

Rows	Name	Relationship to head	Birth Date	Age (Optional)	SS# (last 4 digits)	Student (Y/N)
Head
C0-H
3.
4.
5.
6.
7.
8.

Will all listed minors be living in the unit at least 50% of the time?*

YesNo
1. Have there been any changes in household composition in the last twelve months?*

YesNo
Explain:*
2. Do you anticipate any changes in household composition in the next twelve months?*

YesNo
Explain:*
3. Is there someone not listed above who would normally be living with the household?*

YesNo
Explain:*
4. Are you living with anyone now who will not moving into this unit with you?*

YesNo
Explain:*
5. 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?*

YesNo
6. Are any full-time student(s) married and filing a joint tax return?*

YesNo
7. Are any student(s) enrolled in a job-training program receiving assistance under the Job Training Partnership Act?*

YesNo
8. Are any full-time student(s) a TANF or a title IV recipient?*

YesNo
9. Are any full-time student(s) a single parent living with his/her child(ren) who is not a dependent on another’s tax return and whose children are not dependents of anyone other than a parent?*

YesNo
10. Is any student a person who was previously under the care and placement of a foster care program (under Part B or E of Title IV of the Social Security Act)?*

YesNo
C. INCOME
List ALL sources of income as requested below. If a section doesn’t apply, cross out or write NA
Household Member Name Social Security Gross Monthly Amount
1. *Social Security$*
12. *Social Security$*
13.*SSI Benefits $*
14.*SSI Benefits $*
15.*Pension (list source)$*
16.* Pension (list source)$*
17.* Veteran’s Benefits (list claim #)$*
18.* Veteran’s Benefits (list claim #)$*
19.* Unemployment Compensation$*
20.* Unemployment Compensation$*
21.* Public Assistance (Title IV/TANF etc.)$*
22.* Contributions to the Household (monetary or not)$*
23.* Full-Time Student Income (18 & Over Only)$*
24.* Financial Aid (excluding loans)$*
25.* Annuities (list sources)$*
26.* Long Term Medical Care Insurance Payments in excess of $180/day$*
27.* Scheduled Payments from Investments:$*
28.* Retirement Account Payments (including RMDs):$*
29.* Income From Rental Property:$*
Household Member Name Source of Income Monthly Amount
30.* Employment amount:$*
Employer*
Position Held*
How Long Employed*
31.* Employment amount:$*
Employer*
Position Held*
How Long Employed*
32.* Employment amount:$*
Employer*
Position Held*
How Long Employed*
33.* Previous Employment amount (last 60 days):$*
Employer*
Position Held*
How Long Employed*
34. Alimoney:$*
Do you receive alimony?*

YesNo
List amount you receive:*
$
35. $* Child Support:$
Do you receive formal/informal (money, items, etc.) child support?*

YesNo
List amount you receive:*
36. Other Income:$*
37. Other Income:$*
38. Other Income:$*
39. TOTAL GROSS ANNUAL INCOME (Based on the monthly amounts listed above x 12)*
40. TOTAL GROSS ANNUAL INCOME FROM PREVIOUS YEAR*
41. Do you anticipate any changes in this income in the next 12 months?*

YesNo
42. Is any member of the household legally entitled to receive income assistance?*

YesNo
43. Is any member of the household likely to receive income or assistance (monetary or not) from someone who is not a member of the household as listed on Page 2 etc.)?*

YesNo
44. If yes to any of the above, explain:
45. Is the income received?*

YesNo
D. ASSETS (even if jointly held)

If your assets are too numerous to list here, please request an additional form. If a section doesn’t apply, cross out or write NA.
46. Checking Accounts
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
47. Savings Accounts
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
48. Trust Account
#. Bank: Balance:$
49. Debit cards not associated with a checking account
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
50. Certificates of Deposit (CDs)
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
51. Money Market Accounts
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
52. Savings Bonds
#. Maturity Date:Date Value:$
#. Maturity Date:Date Value:$
#. Maturity Date:Date Value:$
#. Maturity Date:Date Value:$
53. Life Insurance Policy # Cash Value:$
54. Life Insurance Policy # Cash Value:$
55. Mutual Funds
Name #Shares:Interest or Dividend$
Values:$
Name #Shares:Interest or Dividend$
Values:$
Name #Shares:Interest or Dividend$
Values:$
56. Stocks
Name #Shares:Dividend Paid$
Values:$
Name #Shares:Dividend Paid$
Values:$
Name #Shares:Dividend Paid$
Values:$
57. Bonds
Name #Shares:Interest or Dividend$
Values:$
Name #Shares:Interest or Dividend$
Values:$
58. Real Estate Property: Do you own any property?*

YesNO
Type of property:*
59. Location of property:*
60. Appraised Market Value: $*
61. Mortgage or outstanding loans balance due: $*
62. Amount of annual insurance premium: $*
63. Amount of most recent tax bill: $*
64. Is the property subject to foreclosure, bankruptcy or eviction*

YesNo
Describe*
65. Have you sold/disposed of any property in the last 2 years?*

YesNo
Type of Property:*
66. Market value when sold/disposed: $*
67. Amount sold/disposed for: $*
68. Date of transaction:*
69. Have you disposed of any other assets in the last 2 years (Example: Given away money to relatives, set up Irrevocable Trust Accounts)?*

YesNo
Describe the asset:*
70. Date of disposition:

MonthDayYear
Date
71. Amount disposed: $*
72. Do you have any other assets not listed above (excluding personal property)?*

YesNo
Describe*
E. ADDITIONAL INFORMATION
73. Are you or any member of your family currently using an illegal substance?*

YesNo
74. Have you or any member of your family ever been convicted of a felony?*

YesNo
Describe*
75. Have you or any member of your family ever been evicted from any housing?*

YesNo
Describe*
76. Have you ever filed for bankruptcy?*

YesNo
Describe*
77. Will you take an apartment when one is available?*

YesNo
Briefly describe your reasons for applying:*
F. REFERENCE INFORMATION
78. Current Landlord
Name*

First NameLast Name
Address*
Cell Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
How Long?:
79. Prior Landlord
Name*

First NameLast Name
Address:*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
How Long?*
80. Credit Reference #1:*
Address:*
Account #*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
81. Credit Reference #2:*
Address:*
Relationship*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
82. Personal Reference #1: *
Address:*
Relationship*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
83. Personal Reference #2: *
Address:*
Relationship*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
84. Personal Reference #3: *
Address:*
Relationship*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
G. VEHICLE AND PET INFORMATION (if applicable)

List any cars, trucks, or other vehicles owned. Parking will be provided for one vehicle. Arrangements with Management will be necessary for more than one vehicle.
86. Type of Vehicle:*
License Plate #: *
Year/Make:*
Color:*
87. Type of Vehicle:*
License Plate #: *
Year/Make:*
Color:*
88. Do you own any pets?*

YesNo
Describe:*
H. APPLICATION ASSISTANCE
89. Did anyone help/assist you in filling out this application?*

YesNo
Who assisted and what was the reason for the assistance:*
CERTIFICATION

I/We hereby certify that I/We Do/Will Not maintain a separate subsidized rental unit in another location. I/We further certify that this will be my/our permanent residence. I/We understand I/We must pay a security deposit for this apartment prior to occupancy. I/We understand that my eligibility for housing will be based on applicable income limits and by management’s selection criteria. I/We certify that all information in this application is true to the best of my/our knowledge, and I/We understand that false statements or information are punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy. All adult applicants, 18 or older, must sign and date the application.
SIGNATURE(S) (Must be dated):
(Signature of Tenant) *
Date*

MonthDayYear
Date
(Signature of Co-Tenant) *
Date*

MonthDayYear
Date
(Signature of Co-Tenant) *
Date*

MonthDayYear
Date
(Signature of Co-Tenant) *
Date*

MonthDayYear
Date
Should be Empty:

Rental Application Form

Rental Application #102522 KS36810

This is an application for housing at:

Please complete this application and return to:

Section A. GENERAL INFORMATION

B. HOUSEHOLD COMPOSITION

C. INCOME

D. ASSETS (even if jointly held)

46. Checking Accounts

47. Savings Accounts

48. Trust Account

49. Debit cards not associated with a checking account

50. Certificates of Deposit (CDs)

51. Money Market Accounts

52. Savings Bonds

55. Mutual Funds

56. Stocks

57. Bonds

E. ADDITIONAL INFORMATION

F. REFERENCE INFORMATION

78. Current Landlord

79. Prior Landlord

G. VEHICLE AND PET INFORMATION (if applicable)

H. APPLICATION ASSISTANCE

CERTIFICATION

SIGNATURE(S) (Must be dated):