I. Household Composition

I. Household Composition

Unless assistance is required, this form must be completed by the applicant/tenant.List each person who will reside in the unit along with the relationship to the head of household, date of birth, and social security number. Do not include minors who will be present less than 50% of the time. List FT student status for any member who is currently enrolled, expects to become enrolled, or was previously enrolled for any part of 5 months in the calendar year. Include grades K-12; college; university; technical; trade; and mechanical schools.

Rows	Household Member Name	Relationship	DOB	Last 4 of SSN	FT Student?	Phone	Email	Address
1
2
3
4
5
6

Are you looking for units built-out for persons with Disabilities?
Below are the Unit Types available. Which Unit Types are you looking for?
Below are all Unit Types available. Which Unit Types are you looking for?
Reasonable Accommodation Request
Is the anything about your household that you feel it's important for us to understand but there was no space to explain in the application? e.g. you are co-parenting with someone who doesn't live in the household, you are a child's guardian, you are expecting a child.
II. Student Status
Is every member of the household a FT student as defined above?
If NO continue to Section III. If YES please complete the following questions:
Does a student receive assistance under Title IV of the Social Security Act
Was a student previously a foster child?
Is a student enrolled in a program funded by the Workforce Investment Act or similarfederal/state/local program?
Is a student married and eligible to file a joint tax return?
Is a student a single parent who is not claimed as a dependent by another individua
Are the minors in the household claimed as a dependent by a parent?
III. Household Income

Please select all income sources that apply to you and all members your household who are 18 years old or older.
Check all that applies
34. Are any income changes expected in the next 12 months?
Please estimate the total yearly household income for ALL household members who are 18 years and older. This is the annual income before any taxes are taken out.Combined Yearly Household Income for everyone 18 years and older.
Enter a mount
IV. Household Assets

Please select all assets that you and the members of your household possess.
Select all that applies
24. Has anyone received any lumpsum amounts in the past 2 years (i.e. lottery/gambling/inheritance)?
25. Has anyone disposed of any assets for less than fair market value in the past 2 years?
26. What is the combined value of all assets held by all household members over 18 years old?The answer provided here should be the sum of all assets disclosed above. Combined value of all household assets for everyone included in this application.
Under penalties of perjury, I/wecertify that the information presented on this form is true and accurate to the best ofmy/our knowledge. False, misleading, or incomplete information may result in the termination of this application/lease.
Signature
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date

MonthDayYear
Date
Should be Empty:

I. Household Composition

II. Student Status

III. Household Income

IV. Household Assets

Under penalties of perjury, I/wecertify that the information presented on this form is true and accurate to the best ofmy/our knowledge. False, misleading, or incomplete information may result in the termination of this application/lease.