Henry T Wing Lottery

Please read this before answering the next questions.

Definitions of homelessness are:

• Persons living in places not meant for human habitation

• in an emergency shelter

• in transitional housing

• persons who ordinarily sleep on the street or in emergency transitional housing but are spending a short time (30 consecutive days or less) in a hospital or other institution

• person being evicted - for reasons not in their control - within a week from a private dwelling unit and no subsequent residence has been identified and the person lacks theresources and support networks needed to obtain housing

• being discharged within a week from an institution in which the person has been a resident for more than 30 consecutive days and no subsequent residence has been identified and the person lacks the resources and support networks needed to obtain housing.

FAMILY COMPOSITION

List everyone who will occupy the apartment. You must include yourself.

Any person not listed on this form will not be allowed to move in.

EMPLOYMENT

• If the HoH is employed, enter "1" as the Member #.
• If the second household member is employed, enter "2" as the Member # etc etc.
• If one member has multiple jobs, enter their same Member # on multiple rows.

LIST ALL ASSETS

(Assets include Checking Accounts, Savings Accounts, Venmo, Cash App, Direct Express Cards, EBT, DOR Cards, Pay Cards, 401K Accounts, IRA Accounts, Term Certificates, Money Markets, Stocks, Bonds and Mutual Funds)

ADDITIONAL INFORMATION

Conflicts Prohibited

Stratford Capital Group, CHOICE, Inc. and HallKeen as its Agent, agree that no HOME, HSF, or AHT assisted unit will be rented to an individual or immediate family member who is an employee, agent, developer, or sponsor of either HallKeen (when acting as the Agent).

This policy addresses HOME Rule at 24 CFR Part 92.356 provisions to provide guidelines and prevent conflict of interest when conducting management activities at properties with HOME funds. These provisions apply to any individual or any member of an individual’s immediate family who may have decision making functions or responsibilities at properties with HOME funds.

POLICY

Management must implement the necessary procedures to ensure that no HOME assisted affordable housing units are leased to any individual or any member of an individual’s immediate family including those by blood, marriage or adoption, the spouse, parent (including a stepparent), child (including stepchild), brother, sister (including a stepbrother or stepsister), grandparent, grandchild, or in-laws, who is an officer, employee, agent, elected or appointed official, or consultant of the owner, developer, or sponsor of a project assisted with HOME funds whether private for profit or non-profit.

I / We hereby certify that the information furnished on this application is true and complete, to the best of my/our knowledge and belief. Inquiries may be made to verify the statements herein.

All information is regarded as confidential in nature. I hereby authorize the Landlord to obtain a consumer credit report and a criminal background report. I/We certify that I/We understand that false statements or information are punishable under applicable State or Federal Law.

I / We hereby certify that we have received a notice from the management agent describing the right to reasonable accommodations for persons with disabilities.

Signed under the pains and penalties of perjury:

HallKeen does not discriminate on the basis of race, color, creed, religion, national or ethnic origin, citizenship, ancestry, class, sex, sexual orientation, familial status, disability, military/veteran status, source of income, age or other basis prohibited by local, state or federal law in the access or admission to its programs or employment, or in its programs, activities, functions or services.

I, the above-named individual, have authorized HallKeen to verify the accuracy of the information which I have provided to them, from the following sources (specify):

I HEREBY GIVE YOU MY PERMISSION TO RELEASE THIS INFORMATION TO:

HallKeen subject to the condition that it be kept confidential. I would appreciate your prompt attention in supplying the information requested on the attached page to HallKeen within five (5) days of receipt of this request. I understand that a photocopy of this authorization is as valid as the original.

Thank you for your assistance and cooperation.

Signed under pain and penalty of perjury.

To: HallKeen
Re: Release to Obtain Information

In consideration for being permitted to apply for this apartment at Henry T. Wing Residences II, I, Applicant, do represent all information in this application to be true and accurate and that owner/manager employee/agent may rely on this information when investigating and accepting this application. I, Applicant, hereby authorize the owner/manager/agent to make independent investigations to determine my credit, financial and character standing, including, but not limited to, credit and criminal background reports.

I, Applicant authorize any person or credit/criminal background checking agency having any information on me, to release any and all such information to the owner/manager employee/agent or credit checking agencies. Applicant hereby releases, remises, and forever discharges, from any action whatsoever, in law and equity, all owners, managers, and employees, or agents, both of landlord and their credit checking agencies in connection with processing, investigating, or credit checking this application, and will hold them harmless from any suit or reprisal whatsoever.

Pursuant to fair housing laws, advertising/marketing must not indicate any preference or limitation, or otherwise discriminate based on race, color, disability, religion, sex, familial status, sexual orientation, gender identity, national origin, genetic information, ancestry, children, marital status, or public assistance recipient. This prohibition includes phrases such as “active adult community” and “empty nesters”. Exceptions may apply if the preference or limitation is pursuant to a lawful eligibility requirement.

All applicants over 18 must sign:

NOTICE OF RIGHT TO REASONABLE ACCOMMODATION

If you have a disability and you need:

• A change in the rules or policies or how we do things that would make it easier for you to live here and use the facilities or take part in programs on site,
• A change or repair in your apartment or a special type of apartment that would make it easier for you to live here and use the facilities or take part in programs on site,
• A change or repair to some other part of the housing site that would make it easier for you to live here and use the facilities or take part in the programs on site, or
• A change in the way we communicate with you or give you information,

You can ask for this kind of change, which is called a Reasonable Accommodation.

If you can show that you have a disability and if your request is reasonable, if it is not too expensive, and if it is not too difficult to arrange, we will try to make the changes you request.

We will give you an answer within fifteen business days following our review of your information unless there is a problem getting the information we need or unless you agree to a longer time frame. We will let you know if we need more information or verification from you or if we would like to talk with you about other ways to meet your needs.

If we turn down your request, we will explain the reasons and you can give us more information if you think that will help.

If you need help filling out the reasonable accommodation request form, or if you want to give us your request some other way, we will assist you.

You can get a reasonable accommodation request form from your property manager or contact:

HallKeen
1400 Providence Highway, Suite 1000
Norwood, MA
(781) 762-4800