4th at Broadway Lottery

Concatenated Name + SSN + DOB + Property

Office Only - HWs Staff Code

Applicant leave this field BLANK.

Application Date (must match the date stamp on the app)

Date

Application Time (must match the time stamp on the app)

Hour Minutes

AM/PM Option

App entered by HWs staff

Property Description

4th at Broadway Apartments is a mixed-use and residential property located at the intersection of Broadway and Fourth Street. There are a total of 62-unit mixed-income, transit-oriented community consisting of the moderate rehabilitation of an existing 19-unit/commercial building and a new 43-unit building. On-street parking. Nearby Shopping, Dining, and Recreation, as well as access to Public Transportation.

Unit Composition

Units include studios, and 1-, 2-, and 3-bedroom layouts featuring high ceilings, updated kitchens with stainless steel appliances, and in-unit laundry options.

Accessible Units

The development will have five (5) mobility adapted units and two (2) sensory adapted units. First preference for accessible or adaptable units shall be given to applicants requiring the features of the unit in conformity with state and federal civil rights laws.

Utilities

Tenants of the existing 19 units will be responsible for electricity. Tenants of the new addition will be responsible for all utilities.

Preference

A local preference for 70% of the affordable units, for households that currently live in the Town of Chelsea, work for the Town of Chelsea, work in or have been offered or accepted a position in the Town of Chelsea, or have children attending the Chelsea public schools.

The link to the Lottery will be published at this URL once the lottery period is closed, on the 4th at Broadway Apartments Website: https://www.fourthatbroadway.com/

Substring for SSN Widget

I understand that under no circumstances should I submit a second application. Applicants who submit multiple applications may be removed entirely from the lottery. If I made a mistake on my application I should instead email: support@housingworks.net with the SUBJECT LINE: "Requesting a Change to my 4th at Broadway Lottery Application" *

I understand that the person filling out this form will be considered the Head of Household ("HoH") . (If agency staff are assisting the applicant with this form, select "yes")

First Choice Bedroom Size

Second Choice Bedroom Size (okay to pick the same size as previous answer)

Third Choice Bedroom Size (okay to pick the same size as previous answer)

The next questions about are accessibility and/or disability needs. Please note that after the lottery, households who mark “Yes” will be required to provide current verification from the doctor or other medical professional who treats the disability, and the note must verify the need of features.

Does the household include a person with a Handicap or a Disability? READ CAREFULLY BEFORE ANSWERING

If you selected "Handicap" above, please specify if Mobility

If you selected "Handicap" above, please specify if Hearing

If you selected "Handicap" above, please specify if Vision

If you selected "Handicap" above, please specify if Other

If other handicap or disability, specify

Number of adults (18 and over) who will move with you - include yourself in the total since you are the Head of Household.

The number above cannot be "0"

STOP! You entered "0" for the Number of Adults in your household. But you have to include yourself as the Head of Household, so you answer CANNOT BE "0". Scroll back up the page and change your answer or you won't be able to submit this application.

Number of children (17 and under)

Total Household Size

First Name

Full Middle Name

No initials please! Enter your FULL MIDDLE NAME.

HoH All Last Names you have ever used, including previous married names

Ex: Smith Johnson Alves

Re-Enter Your Name THE SAME as you entered it above

First NameCOMPLETE Middle NameALL Last Names Ex: Smith Johnson Alves

Today's Date (Used to Calculate Age)

Date

Head of Household's DOB

mm-dd-yyyy

Based on your birthdate, your age is:

Do you, the Head of Household, have a SSN or ITIN??

Enter your COMPLETE SSN or ITIN

You MUST include the dashes, see example

Applicant # 1 Address Line 1 (enter only the street number, street name, and the word St or Ln or Blvd, etc.)

Applicant # 1 Address Line 2 ONLY (enter only an Apt Number or c/o Name)

Applicant # 1 City or Town ONLY

Applicant # 1 State ONLY

Applicant # 1 Zip Code ONLY

Applicant # 1 Email address

Enter only a personal email address that you will keep for many years.

Applicant # 1 Cell Phone Number.

This can be the phone number of a relative, friend, or social service agency from which you receive assistance. We must have at least one phone number for you. If none, type 999-999-9999.

Applicant # 1 Home Phone Number

Applicant # 1 Work Phone Number

Gross MONTHLY Income from the Head of Household (the person filling out this for) - include welfare, child support, food stamps, etc. If zero, write "0".

Round your answer to the nearest dollar. Don't type a "$" sign, and don't add a decimal point.

Gross ANNUAL Income from the Head of Household) - include welfare, child support, food stamps, etc. If zero, write "0".

List the Sources of Income for the Head of Household - including any investment income)

If you have zero income, then type "N/A". But remember that even food stamps can be considered income.

Value of all Assets held by the Head of Household. If zero, write "0"

Round your answer to the nearest dollar. Don't type a "$" sign, and don't add a decimal point.

Is the Head of Household a Full-Time Student?

SECOND Household Member - Full Name

First NameComplete Middle NameLast Name

SECOND Household Member - Relationship

Does SECOND Household Member have a SSN or ITIN?

SECOND Household Member - SSN or ITIN

SECOND Household Member - Date of Birth

mm-dd-yyyy

Based on your birthdate, second HH member's age is:

SECOND Household Member - Full-Time Student?

Is Applicant # 2's address the same as the Applicant's?

Applicant # 2 Address Line 1 ONLY (include Street Number, Name, and Apt Number)

Applicant # 2 City or Town ONLY

Applicant # 2 State ONLY

Applicant # 2 Zip Code ONLY

Applicant # 2 Email address

Enter only a personal email address that you will keep for many years.

Gross MONTHLY Income for this SECOND HH Member - include welfare, child support, food stamps, etc. If zero, write "0".

Round your answer to the nearest dollar. Don't type a "$" sign, and don't add a decimal point.

Gross ANNUAL Income for this SECOND HH Member

Value of all Assets held by this SECOND HH Member. If zero, write "0"

Round your answer to the nearest dollar. Don't type a "$" sign, and don't add a decimal point.

Gross Annual Income from ALL Household Members

Do you currently hold a mobile voucher?

If you have a mobile voucher, please name the Agency or Housing Authority that gave you the voucher.

Current Building Number

Current Unit Number

EQUAL OPPORTUNITY / FAIR HOUSING INFORMATION

The following information Will be required by the Federal Government to monitor this owner / management agent’s compliance with Equal Housing Opportunity and Fair Housing Laws. The law provides that an applicant may not be discriminated against on the basis of the information supplied below whether or not the information is furnished.

You are requested to complete the following optional section in order to assist in determining preference. If you prefer not to answer, select "Choose not to provide"

Ethnic Category OPTIONAL

Race Category OPTIONAL

Preferences (Optional) Local preference for 70% of the units during the Initial Application Period. Are you a Chelsea resident, employed in Chelsea, or have students in School in Chelsea?

How did you hear about this housing opportunity?

EQUAL OPPORTUNITY / FAIR HOUSING INFORMATION

Peabody Properties, Inc. does not discriminate on the basis of race, color, religion, national origin, gender, disability, familial status, marital status, sexual orientation, genetic information, veteran/military status, receipt of public assistance, ancestry, age, gender identity or other basis prohibited by federal, state, or local law in the access or admission to its programs or employment or its programs, activities, functions or services.

The following information will be required by the Federal Government to monitor this owner / management agent's compliance with Equal Housing Opportunity and Fair Housing Laws. The law provides that an applicant may not be discriminated against on the basis of the information supplied below whether or not the information is furnished.

I understand and grant permission for all of the above information to be verified by the owner / agent. I further understand and grant permission to authorize a credit bureau service to make any consumer report and investigative consumer report, whereby information is obtained through public records, personal or telephonic interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry may include information as to my character, credit worthiness, credit standing, and credit capacity. I understand that I have the right to make a written request within a reasonable period of time to receive information about the nature and scope of any such report that is made.

Please Read each item below carefully before you sign.

I hereby certify that the information provided in this application is correct to the best of my knowledge.
I understand that this is a application and the information provided does not guarantee housing. Additional information and verifications will be necessary to complete the standard application process.
I understand that under no circumstances should I submit a second application, as applicants who submit multiple applications may be removed from the lottery entirely. If I made an error on my application, I should instead email support@housingworks.net with the subject line: “Requesting a Change to my 4th at Broadway Lottery Application.” After the Lottery period, all updates should be sent to the Property, using this contact form: https://www.fourthatbroadway.com/apartments/ma/chelsea/contact

Signatures

All household members 18 and older must sign.

Head of Household's Signature

Second Adult's Signature

Third Adult's Signature)

The size of your household is greater than six (6) people, so you will likely not qualify for any unit in this lottery. You might not get entered into the lottery.

Household sizes and income limits are set by the funders for this program and the management company must comply with them.

If you have questions, please contact Peabody Properties and ask to speak with the staff contact for Baldwinville School Apartments Lottery:

857.281.1494

You indicated this may be your second submission. You are not allowed to submit a second application. so the SUBMIT button has been removed from this page.

If you answered in error and this is NOT your second application, go back and find the question "I understand that under no circumstances should I submit a second application. Applicants who submit multiple applications may be removed entirely from the lottery. If I made a mistake on my application I should instead email support@housingworks.net with the SUBJECT LINE: Update to Baldwinville School Apartments Application."

Applicants, press the Submit button above now.

If you see the following error message, click the words "See Errors". This will jump you to any questions that still need an answer.

Once you push the Submit Button, you won't be able to change any of your answers - so it is a good idea to click the tabs at the top of this application, and review all your answers before you press Submit.

Do you need a unit that is modified to assist with a mobility, hearing, or vision problem?

Income Status

Market Rent

Rent Eligibiity

Latest Outcome

History and Notes

Likely Waitlist Assignments

Eventually Concatenate into One Column, separated by commas

Master - all Applicants are added to Master

Needs Mobility Accessible Unit X=True BLANK = False

Needs Hearing Accessible Unit

Needs Vision Accessible Unit

Preference Disability

Preference Displaced

Preference Elderly

Preference ElderlyDisabled

Preference ExistingResidentTransfer

Preference Homeless

Preference IncomeExtremelyLow

Preference IncomeLow

Preference IncomeVeryLow

Preference MilitaryPersonel

Preference RentExceeds50PercentIncome

Preference Residency

Preference SubstandardHousing

Preference VictimsOfDomesticViolence

Preference WorkingFamily

Preference IncomeModerate

Preference LOPE

Preference LocalPublicHousingAuthority

4th at Broadway Lotteryin Chelsea