Live in Oak Park Client Registration Form

Please fill out the following form so that we can best serve you during your apartment search!

All information will remain confidential and will only be used by the 'Live in Oak Park' Rental Advisors at the Oak Park Regional Housing Center.

Once you submit your form, a Rental Advisor will contact you with apartment listings that match your needs!

If you are having any difficulty filling out the form, please call our office at 708-848-7150 for assistance.

Today's Date *

Date

Your Name *

First Name Last Name

Your Current City of Residence *

State or Other Continent/Country *

Phone *

Area Code Phone Number

Email *

example@example.com

Total Combined Annual Household Income *

Credit Score (if known)

If you do not know your exact credit score, please select your current credit rating *

Good Average Poor I'm not sure No credit score established

When is the absolute earliest date you can move? *

Date

When is the absolute latest date you can move? *

Date

Anticipated Maximum Rent Budget *

Total Persons (Including Children) to Occupy Apartment *

Bedrooms Needed *

Check if you require pet friendly listings

Allows dogs Allows cats

Special Requirements (For example: Near the Blue Line, Top Floor, Hardwood, etc.)

How did you learn about us? *

Are you using a Housing Choice Voucher? *

Yes No

The information on this intake form will remain confidential. However, it is vital funding/grant information required for reporting in aggregate to HUD and all content on this page is required by HUD. Please complete below:

Are you (or another household Adult) of Hispanic / Latinx ethnicity? If yes, please check "White" for Racial Identity in the section below as well. *

Yes No

Are you (or another household Adult) of Arab or Middle Eastern ethnicity? *

Yes No

Are you a female head of household (the member of the family who has been designated by the family as the head for purposes of determining income eligibility and rent)? *

Yes No

Racial Identity: Please Indicate the Race(s) of Adults in the Household. Check all that apply. *

You

2nd Adult

3rd Adult

White
A person having origins in any of the original people of Europe, the Middle East or North Africa

Black / African American
A person having origins in any of the black racial groups in Africa or the Caribbean

Asian
A person with origins in any of the peoples of the Far East, Southeast Asia or the Indian subcontinent including for example: Afghanistan, Bangladesh, Cambodia, China, India, Japan, Korea, Laos, Malaysia, Mongolia, Pakistan, Philippine Islands, Thailand and Vietnam

American Indian / Alaskan Native
A person having origins in North, Central or South America who maintains a tribal community attachment (not just claim of ancestry)

Native Hawaiian / Other Pacific Islander
A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands

American Indian or Alaska Native AND White

Asian AND White

Black / African American AND White

American Indian / Alaska Native AND Black / African American

Your signature below indicates that you accept disclosure of your new address (or nearest cross streets) as terms of agreement for our service.

Draw your signature using your mouse or finger / stylus if you are using a touchscreen device.

Signature *

Clear

Certification: I certify that the information on this registration form is true and correct as of the date with my signature here and acknowledge my understanding that any intention or negligent misrepresentation(s) of the information contained on this form may result in civil liberty and or criminal penalties including, but not limited to, fine or imprisonment or both under the provision of Title 18, United States Code, section 1002, et seq.

Date *

Date

For Office Use Only: The following section is to be filled out by the Housing Center. Please do not answer any of the following questions.

ID #: Advisor: Admin / Public Service

G: Date: Time:

Final Result: Date:

Close-Out Date: Aff Move? Y / N

Listings: