Alexan Waltham Affordable Housing Lottery

Alexan Waltham Affordable Unit Lottery Application

There are 5 sections in this form. You must complete every page, but you can save the form and come back to it, but note that your form will not be submitted until you complete every page (and then at the end you should receive a THANK YOU note with a reference number). You will be asked to provide the names of every person who will be living in the unit, starting with yourself. NOTE THAT SUBMITTING MULTIPLE APPLICATIONS WITH ANY OF THE SAME ADULT HOUSEHOLD MEMBERS WILL INVALIDATE ALL APPLICATIONS SUBMITTED UNLESS YOU NOTIFY US THAT YOU ARE RESUBMITTING TO MAKE CHANGES OR UPDATES TO YOUR ORIGINAL SUBMISSION.
For the best online user experience, we recommend using a private browsing tab (like Incognito in Chrome) so the form does not auto-fill in any incorrect information.

If you receive a bad gateway error message, check your Inbox for confirmation that your application was received (because if you receive an email, that means your online application was transmitted).

Online Applications and Paper Applications must be completed and Paper Applications must be submitted by February 17th, 2025.

Submitting multiple applications with any of the same adult household members will invalidate all applications submitted unless you notify us of your multiple submissions.

This is an important document. If you require language interpretation, please contact the agent for this development directly (info@sebhousing.com or 617-782-6900 x3) and request interpretation services in your own language. If the agent does not speak your primary language they will contact a translator who will provide language assistance.

Este es un documento importante. Si necesita interpretación de idiomas, comuníquese directamente con el agente de este desarrollo (info@sebhousing.com y 617-782-6900 x3) y solicite servicios de interpretación en su propio idioma. Si el agente no habla su idioma principal, se pondrá en contacto con un traductor para que proporcione que brindará asistencia lingüística.

60% AMI MAXIMUM Household Income Limits:

$68,520 (1 person), $78,360 (2 people), $88,140 (3 people) $97,920 (4 people), $105,780 (5 people), $113,640 (6 people)

80% AMI MAXIMUM Household Income Limits:

$91,200 (1 person), $104,200 (2 people), $117,250 (3 people) $130,250 (4 people), $140,700 (5 people), $151,100 (6 people)

Rents for the 60% units are: 1BR at $1,741, 2BR at $2,080, 3BR at $2,395

Rents for the 80% units are: Studio at $2,200, 1BR at $2,347, 2BR at $2,808, 3BR at $3,235

Tenants will pay the cost of electricity (including heat, cooking, hot water). Water and sewer charges are included in the rent. One complimentary parking space is available for residents. Tenants of 2BR and 3BR units may have access to a second parking space. Pets are allowed, subject to restrictions.

*Rents for the units available in 2026 are subject to change. If the AMI increases or the utility allowances decrease, the rent may increase as further described in the Regulatory Agreement, which is a recorded document in the Middlesex South Registry of Deeds.

For 60% AMI Units: Households must make approximately $52,200 to lease an 1BR unit, $62,400 to lease an 2BR unit and $71,800 to lease a 3BR unit (please read the Information Packet for more details).

For 80% AMI Units: Households must make approximately $66,000 to lease a Studio unit, $70,400 to lease an 1BR unit, $84,200 to lease an 2BR unit and $97,000 to lease a 3BR unit (please read the Information Packet for more details).

The Information Packet and more details on the lottery and the units can be found at the property listing here:

https://sebhousing.com/property/alexan-waltham/

For questions on this form, please email info@sebhousing.com

This development does not discriminate in the selection of applicants on the basis of race, color, national origin, disability, age, ancestry, children, familial status, genetic information, marital status, public assistance recipiency, religion, sex, sexual orientation, gender identity, veteran/military status, or any other basis prohibited by law.
For the best online user experience, we recommend using a private browsing tab (like Incognito in Chrome) so the form does not auto-fill in any incorrect information.

IF you receive a bad gateway error message, check your Inbox for confirmation that your application was received (because if you receive an email, that means your online application was transmitted).
GENERAL INFORMATION
Email address*

Confirmation EmailRe-enter to confirm your email address match.
Applicant's Name*

First NameLast Name
Current / Mailing Address*
Street Address
Street Address Line 2
Street Address Line 2
City*
City
State*
State
Zip Code*
Zip Code
Cell Phone*
Please enter a valid home phone number.
Home Phone
Please enter a valid work phone number.
Work Phone
Please enter a valid cell phone number.

INCOME
Instructions for completing the following income fields/questions
For the purpose of income determination, “Household” shall mean all persons whose names appear on the lease, and also all persons who intend to occupy the housing unit as their permanent primary residence, even if they are not included on the lease. Legally married couples shall both be considered part of the household, even if separated. The incomes of all household members will be included, with the exception of income from employment for household members under the age of 18 or any income from employment over $480/year of full-time students who are also dependents of a household member who is also occupying the unit (but please note that documentation of income for those dependents still needs to be supplied).

Please note:

1.      Gross income from current wages, salaries, tips, etc. is the full amount, before any deductions, and is the amount used to determine estimated current annualized income.

2.      For self-employed applicants- include the contract or job name in the space provided. You will be directed to all the additional documentation you will need to submit in Section 2.

3.      “Interest Income” refers to any amount that you receive from any asset except for amounts drawn down from a retirement account or 401K as those go on the lines for “pension” or “retirement funds”.
Source of Income

You must list the combined total income for every person who will be occupying the unit in the following fields.
Income/Wages from Employment for ALL household members:
Annual / Yearly GROSS Income
Income/Wages From Self-Employment for ALL household members (please note Self-Employment income is NET income):
Annual / Yearly NET Income (ONLY self employment income is NET income)
Annual Child Support Received:
Annual / Yearly GROSS Income
Annual Alimony Received:
Annual / Yearly GROSS Income
Annual Total Social Security Income and SSDI for ALL household members:
Annual / Yearly GROSS Income
Annual Pension income received from all sources:
Annual / Yearly GROSS Income
Total distributions taken annually from ALL Retirement Accounts:
Annual / Yearly GROSS Income
Total Expected Unemployment Wages For Next 12 Months (note: do NOT count FPUC (Federal Pandemic Unemployment Compensation) as it is not counted for this Program):
Annual / Yearly GROSS Income
Total Expected Workman’s Compensation for Next 12 Months:
Annual / Yearly GROSS Income
Total Expected Severance Pay Next 12 Months:
Annual / Yearly GROSS Income
TAFDC/EAEDC:
Annual / Yearly GROSS Income
Full-Time Student Income. For full time students earning MORE than $480/yr in employment income who are ALSO dependents of another person on this application, please just put $480 here, as that is the max employment income counted toward the household's total income.
Annual / Yearly GROSS Income
Total of periodic payments from family/friends & Recurring Gifts for one year (i.e. rent assistance from family)
Annual / Yearly GROSS Income
Interest earned on all asset accounts over one year:
Annual / Yearly GROSS Income
If you own property and receive rent, the total amount of annual rental income from your real estate holdings
Annual / Yearly GROSS Income
Check here if there is Bonus income NOT reflected in the table above (such as End-Of-Year Bonuses, anticipated raises). You will be prompted to provide details (ex: “John Doe will receive a $1,000 bonus at the end of the calendar year.”

Yes, I have Bonus income
Bonus Income Details (provide text and explanations here, the box on the right is for the actual dollar amount)
Total Dollar Amount of Expected Bonus Income over next 12 months
Check here if there is any other income NOT reflected in the table above. Please note that the dollar amount provided here will be reflected in your income total. This provides applicants the opportunity to provide clarification on the income estimates, and if households with to clarify wages or other income, it can be put here and should be removed from the table above

Yes, I have other income
“Other” Income Details (provide text and explanations here, the box on the right is for the actual dollar amount)
Total Dollar Amount of “Other” Income over next 12 months
#(HIDDEN) Your Total Household Annual Income Based on the information provided above, is
This is calculated based on the amounts submitted above.
Your Total Household Annual Income Based on the information provided above, is
This is calculated based on the amounts submitted above.
Please note, your Total Household Annual Income is higher than the maximum income allowed for your household size for this program. If you made a mistake, please fix your prior answers. Otherwise, you will be found ineligible for the program when your online application is reviewed in 1-2 weeks.
Total Annual Household income:*

Check here to confirm your Total Annual Household Income above is accurate. If it is not, you should update your answers in the Income Table until the Total Annual Household Income is accurate. You may also use the “Other Income” question to provide clarification, but the number next to “Other Income” must still be your best estimation of the Income/Wages you are clarifying.

ASSETS

You must list the total combined assets for every person who will be occupying the unit in the following fields.
Please note that for retirement accounts, households should provide the NET amount of their retirement accounts (which is the amount if they were to withdraw the full amount today and if there were early withdrawal penalties).

Additionally, if any household member has divested themselves of an asset for less than full and fair present cash value of the asset within two years prior to this application, the full and fair cash value of the asset at the time of its disposition must be listed below.
Total Amount in All Checking Accounts
Total Assets
Total Amount in All Savings Accounts
Total Assets
Total Amount in All Venmo/ Paypal / Cash-App Accounts
Total Assets
Total Amount in Trusts (that you can access):
Total Assets
Total Amount in Certificates/CDs
Total Assets
Total Amount in Savings/Treasury Bonds
Total Assets
Total Amount in Stocks, Bonds, Mutual Funds
Total Assets
Total Amount in Money Market Accounts
Total Assets
Total Amount in Currency Holdings (cash on hand, cryptocurrency etc.)
Total Assets
Total Balance in 401(K)s
Total Retirement Assets
Total Balance in IRAs
Total Retirement Assets
Total Balance in Annuities
Total Retirement Assets
Total Balance in all other Tax-Deferred Retirement Accounts
Total Retirement Assets
Do you or anyone on this application currently own a home (including an investment home) or are listed on the deed for any home?*

YesNo
If YES, what is the Total Net Equity (Appraised Value minus mortgage or outstanding loans) on all real estate owned?
##TOTAL for retirement assets
##TOTAL for non-retirement assets
(HIDDEN) Based on the information provided above, your Total Non-Retirement Households Assets (that count toward the Asset Limit) are:
This is calculated based on the amounts submitted above.
Total Assets - Based on the information provided above, your Total Assets for your household are:
This is calculated based on the amounts submitted above.
Please note, your Total Assets are over the Asset Limit of $75,000. If you made a mistake, please fix your prior answers.

Please also note that the NET amount of your retirement accounts should be listed (so just include the amount that you would have in cash (post-penalty) from those retirement accounts if you were to withdraw the full amount today and incur the early-withdrawal penalty. Otherwise, if your Total Assets are over $75,000, you will be found ineligible for the program when your online submission is reviewed in 1-2 weeks.”
$$ #2 copy Total Assets - Based on the information provided above, your Total Assets for your household are:
Total Household Assets:*

Check here to confirm that your Total Assets listed above is accurate.

Please read each item below carefully before you sign.
1. I hereby declare under pain and penalty of perjury that the information provided on every page of this application is true and correct. I understand that if any sources of income or assets are not disclosed on this application, or any information provided herein is not true and accurate, this application may be removed immediately from further consideration and I will no longer be allowed to reserve a unit.
2. I understand that the income and asset numbers I disclose will determine my eligibility for this lottery AND the Waiting Lists on which I will be placed, and that if the income and/or assets I disclose in this Application are less than my total income and/or assets when counting all sources as detailed in this Application and the Information Packet, and/or if my income is higher on the final date of Certification than what I disclosed in this Certification Application, and as a result I am not eligible for the unit(s) designated for the Waiting List(s) I will be placed on as a result of the information disclosed herein, then I will not be able to be added to any other Waiting List based on my position in the original drawing, but rather I will be added to the bottom of the Waiting Lists for which I am eligible as determined by my income at final Certification
3. I acknowledge that if I have submitted an application prior to this current submission, that any and all previous application submissions will be wholly replaced by this current application submission, as only ONE entry is allowed per person or household.
4. The undersigned certify that none of the people listed in this application, or their families, have a financial interest in the development and none of the people listed in this application can be considered a Related Party by the affordable housing guidelines that govern this property.
5. The undersigned certify that the affordable unit will be undersigned’s principal residence and the undersigned cannot own a home elsewhere or in trust while living in an affordable unit.
6. I understand that the lease or residency agreement for the units to be occupied through this affordable housing program may be subject to cancellation if any of the information above is not true and accurate.
7. I understand that this is a preliminary application and the information provided does not guarantee housing.
8. I understand this is not a lease application and if given the opportunity to move forward in the process of leasing an affordable unit, and by given deadlines I will need to complete Program Certification and a lease application where my affordable housing program and lease eligibility will be determined by additional factors such as credit score, tenant history and criminal background screening. I understand that if selected high enough in the lottery to move forward, I will need to be able to submit all required income, asset, tax and if applicable, local preference documentation within 10 days of the lottery deadline and failure to submit the required documentation in time, or to meet any other deadlines given by SEB or the management company, will result in my removal from the Waiting List.
9. I understand that any material change in the income or assets of my household, or my household composition, that occurs after the submission of this application may make me ineligible for affordable housing. I understand that any changes to income or assets that may put my household into another income tier must be reported to SEB.
10. Co-signers and Guarantors are not permitted unless they are co-tenants who will reside in the unit.
11. I acknowledge that if my email address is provided in this application, SEB will correspond with me by email instead of postal mail unless I make a written request otherwise. I understand that any changes to my contact information must be reported to SEB.
12. I acknowledge that the determination of eligibility by SEB Housing is based upon the guidelines that govern the Affordable Housing Program for the development and, as such, barring any confirmed error by SEB Housing in applying the guidelines and/or calculating income, the decision is final and I further agree to hold harmless SEB Housing from any claim(s) related to this application.
13. The undersigned give consent to the City of Waltham, SEB Housing LLC, MassHousing, and Alexan Waltham to verify the information provided in this application. The undersigned authorize the release of information necessary in determining income and assets from third-party references.
Signature*

Clear
Date Signed

MonthDayYear
Date
This development does not discriminate in the selection of applicants on the basis of race, color, national origin, disability, age, ancestry, children, familial status, genetic information, marital status, public assistance recipiency, religion, sex, sexual orientation, gender identity, veteran/military status, or any other basis prohibited by law.
Should be Empty:

Alexan Waltham Affordable Unit Lottery Application

GENERAL INFORMATION

HOUSEHOLD AND UNIT SIZE/TYPE

Please select from the available unit sizes. Please note that if multiple unit sizes are available, households may apply for more than one unit size.

For MassHousing developments, a 1 person household may not occupy a 2BR unit and a 2 person household may not occupy a 3BR unit unless they have a medical need for an extra bedroom and/or a reasonable accommodation to live in a unit with more bedrooms than household members.

LOCAL PREFERENCES AND ADDITIONAL INFO

REASONABLE ACCOMMODATION

RELATED PARTY

INCOME

Instructions for completing the following income fields/questions

Source of Income

ASSETS