Housing Intake Pre-Application

Housing Intake Pre-Application
This short form helps Northwest Neighborhoods (NWN) identify currently available units that may be a possible match for your household. It is not a rental application, does not place you on a waiting list, does not reserve a unit, and does not guarantee eligibility. If you are interested in an available unit, NWN may contact you to schedule a showing. A full application and verification process is required before approval.
1) Contact Information
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
Preferred Contact Method:
2) Household
How many people are in your household?
Bedrooms needed/preferred:
Do you need an accessibility feature or reasonable accommodation as part of your housing?
If you would like an accessibility feature or reasonable accommodation, briefly describe what you need:
Is the head of household a full-time student?
Do you have an assistance animal with documentation?
Do you have any pets?
3) Housing Assistance/Voucher
Do you currently have a housing voucher or rental assistance?
If yes, program/provider (for example CMHA, EDEN, other):
Is this temporary assistance or a long-term voucher?
4) Units You Are Interested In
Please identify all available units currently listed on the Leasing webpage that you would consider. Seeing more than one appropriate unit may give you more options based on your eligibility. You must list specific units to be considered.
First choice:
Other unit(s) you would consider:
I am open to being contacted about other NWN units that appear to fit my household and income.
5. Household Income - Quick Estimate
Why we ask: Many NWN apartments have income requirements. Please give us the best picture you can of money regularly coming into the household. An estimate is okay at this stage. If you later apply, NWN will request documents and formally verify income.

Paychecks / Employment - For each adult working household member, tell us how often they are paid and about how much the check is before taxes/deductions (gross pay), if known.

Rows	Paid how often:	Approx. gross amount per check:	Hours/week (if known):
Household Member 1
Household Member 2
Other Household Members

Do you receive income from other work/cash/side jobs - Include regular or occasional work that may not come through a standard paycheck, such as cleaning, childcare, construction, gig work, tips, cash work, self-employment, or other side jobs.
Approximately how much money comes from other work/cash/side jobs?
How frequently is this income received?
Do you receive income from Social Security/disability/retirement/benefits?
How much do you receive per month?
Do you receive income from child/spousal support/other regular financial support payments?
How often do you receive these payments?
How much do you receive?
Other income not listed above? Please list amount and how often you receive these payments.
7. Pre-Application Acknowledgment
I understand this is a pre-application/intake form, not a formal rental application.
I understand submitting this form does not reserve a unit or establish my place in line for a unit.
I understand I must view a unit before submitting/using a formal application for that unit under NWN's leasing process.
I understand the income amounts provided here are estimates and will need to be documented and verified if I formally apply.
I understand NWN may use this information to contact me about currently available units that appear to be a potential match.
Name:
Date:
Should be Empty:

Housing Intake Pre-Application

1) Contact Information

2) Household

3) Housing Assistance/Voucher

4) Units You Are Interested In

5. Household Income - Quick Estimate

7. Pre-Application Acknowledgment