• ILP APPLICATION

  • Application due by: September 30, 2026 at 4:00 PM

    APPLICATION FOR RESIDENTIAL OCCUPANCY AT FRASER INDEPENDENT LIVING THROUGH THE DEPARTMENT OF HOUSING & URBAN DEVELOPMENT (HUD) FUNDING SPECIFIC TO FRASER INDEPENDENT LIVING

  • I am applying to the waiting list for the following apartment building(s):*
  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • If you have no Social Security Number, you claim you are exempt because:
  • Date of Birth:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Gender:*
  • Please list the names of two persons through whom you can always be reached – i.e. relatives, case manager, etc.

  • PROGRAM ELIGIBILITY:

    You must have a primary diagnosis of a developmental disability.

    Developmental Disability as defined in CFR 42 U.S.C. 6001
    The term "developmental disability" means a severe, chronic disability of an individual 5 years of age or older that—
    (A) is attributable to a mental or physical impairment or combination of mental and physical impairments;
    (B) is manifested before the individual attains age 22;
    (C) is likely to continue indefinitely;
    (D) results in substantial functional limitations in three or more of the following areas of major life activity:

    (i) self-care;
    (ii) receptive and expressive language;
    (iii) learning;
    (iv) mobility;
    (v) self-direction;
    (vi) capacity for independent living; and
    (vii) economic self-sufficiency; and

    (E) reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, supports, or other assistance that is of lifelong or extended duration and is individually planned and coordinated, except that such term, when applied to infants and young children means individuals from birth to age 5, inclusive, who have substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in developmental disabilities if services are not provided.

  • Do you have a developmental/intellectual disability? (You will need to provide verification of your developmental disability to be accepted on the waiting list. A verification of disability form will be mailed to you to have completed by your physician, licensed RN, licensed therapist, or licensed social worker.)*

  • HOUSEHOLD COMPOSITION AND CHARACTERISTICS:

  • Are you enlisted in the US Military or are you a veteran of the US Military?*
  • Are you currently receiving housing assistance from HUD or a PHA?*
  • Have you ever been asked by a landlord to sign a repayment agreement to return money to HUD?*
  • Are you a student enrolled in an institute of higher education?*
  • Have you ever been convicted of a crime?*
  • If yes, what is the conviction(s)
  • Are you or anyone in your household subject to State lifetime sex offender registration in any state? (Each applicant will be screened at application and yearly on the national sex offender database.)*
  • Have you ever been evicted from a federally funded housing program for a lease violation including drug use or failure to report a crime?*
  • Are you currently homeless?*
  • Where are you currently living?*
  • Will another person be living in the apartment with you?*

  • If yes, and another adult, please know that all adults must complete their own application.
    Please list other person living in unit with you.

  • Date of Birth:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you plan to house an animal in the unit?*
  • Do you require any special unit feature? Fraser may verify the need for a special feature.

  • Fraser Independent Living properties are Smoke Free.

  • Do you agree that you, your guests and service providers hired by you will abide by the Smoke Free policy?*
  • Do you understand that failure to comply with Smoke Free policies in the Tenant Guidebook will result in termination of tenancy (eviction)?*
  • Marijuana use, recreational or medicinal, is not allowed on HUD subsidized properties. Do you agree that you, your guests and service providers hired by you will abide by the no marijuana use policy?*
  • Do you understand that failure to comply with the no marijuana use policy in the Tenant Guidebook will result in termination of tenancy (eviction)?*

  • INCOME AND ASSET INFORMATION:

  • Are you employed?*

  • How much do you expect to receive in income in the next 12 months?

  • Do you receive any benefits on a debit card?*

  • What is your current balance in the following accounts:

  • Is the Trust Fund a Special Needs Trust Fund?
  • Do you receive any assistance in paying your utility bills?*
  • Have you disposed of any assets for less than fair market value in the previous two year period?*

  • Deductions

    Income can be reduced based on the amount of qualified monthly out of pocket medical, dental, and other related healthcare expenses.
  • Do you pay for medical assistance?*
  • Do you take prescription drugs on a regular basis?*
  • Do you anticipate that any medical, dental, and other related healthcare expenses within the next 12 months will not be covered by medical insurance? This includes the cost of over-the-counter medical expenses to treat a specific medical condition verified by your physician as well as mileage to and from medical appointments.*
  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Fraser will update the waitlist every year, asking individuals if they would like to remain on the list and informing them of any changes. It is very important that all applicants keep Fraser updated on their addresses and contact information so that we are able to contact you when there is a vacancy.

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