Do you RENT or OWN

If owned, do you receive monthly rental income from property?

Check utilities paid by you:

Do you have a Section 8 Voucher or any other type of voucher?

How did you hear about this property?


"List ALL persons who will live in the apartment. List the head of the household first."

No. Name: Relationship to head Marital Status: Birth Date: Age: SS#: Student:

Have there been any changes to the household composition in last twelve months?

Do you anticipate any changes in household composition in the next twelve months?

Is there someone not listed above who would normally be living with the household?

Is anyone in the household 62 years of age as of January 1, 2010, who does not have a social security number and was receiving HUD rental assistance a current or previous residence?

Will ALL of the persons in the household be or have been full-time students during five calendar months of this year or plan to be in the next calendar year at an educational institution (other than a correspondence school) with regular faculty and students?


Are any full-time student(s) married and filing a joint tax return?

Are any student(s) enrolled in a job-training program receiving assistance under the Job Training Partnership Act?

Are any full-time student(s) a TANF or a title IV recipient?

Are any full-time student(s) a single parent living with his/her minor child who is not a Dependent on another’s tax return?

Is any student a person who was previously under the care and placement of a foster care program (under Part B or E of Title IV of the Social Security Act)?

Household Member Name: Source of Income Gross Monthly Amount:

Do you anticipate any changes in this income in the next 12 months?

Is any member of the household legally entitled to receive income assistance?

Is any member of the household likely to receive income or assistance (monetary or not)?

From someone who is not a member of the household listed on page 5 etc.?

Is the income received?


Real Estate Property

Do you own any property? Yes No Radio buttons, default no

Does any member of the household have an asset(s) owned jointly with a person who is NOT a member of the household?

Do they have access to the asset(s)? Yes No Radio buttons, default no

Have you sold/disposed of any property in the last 2 years?

Have you disposed of any other assets in the last 2 years (Example: Given away money to relatives, set up Irrevocable Trust Accounts)?

Do you have any other assets not listed above (excluding personal property)?


Are you or any member of your family currently using an illegal substance?

Have you or any member of your family ever been convicted of a felony?

Have you or any member of your family ever been evicted from any housing?

Are you, or any member of your household required to register on the lifetime sex offender registry in any state?

Have you ever filed for bankruptcy?

Will you take an apartment when one is available?


Current Landlord

Prior Landlord

Credit Reference #1:

Credit Reference #2:

Credit Reference #3:

Personal Reference #1:

Personal Reference #2:


Personal Reference #3:

In case of emergency notify:

List any cars, trucks, or other vehicles owned. Parking will be provided for one vehicle. Arrangements with Management will be necessary for more than one vehicle.

Do you own any pets?

Is your pet moving into the apartment?

Is your pet current with all vaccines?


I/We hereby certify that I/We Do/Will Not maintain a separate subsidized rental unit in another location. I/We further certify that this will be my/our permanent residence. I/We understand I/We must pay a security deposit for this apartment prior to occupancy. I/We understand that my eligibility for housing will be based on applicable income limits and by management’s selection criteria. I/We certify that all information in this application is true to the best of my/our knowledge and I/We understand that false statements or information are punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy. All adult applicants, 18 or older, must sign application.


Your signature on this form, and the signatures of each member of your household who is 18 year of age or older, authorizes the U.S. Department of Housing and Urban Development (HUD) and New Neighborhoods, Inc. to obtain credit, criminal and sex offender information.

Sensitive Information: the consent granted by this form may be used as basis to collect sensitive information which is protected by the Privacy Act. Such information will not be disclosed or released outside of HUD except to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory investigators and prosecutors. Please see the Federal Privacy Act Statement for a more detailed description of your privacy rights.

Instructions: Each adult member of the household must sign the form as part of the application process. Additional signatures must be obtained from new adult members whenever they join the household.

Conditions: I agree that photocopies of this authorization may be used to obtain necessary credit and criminal information. If I or any adult member of my household fails to sign this authorization, I understand that this action may constitute ground s for denial of eligibility.

New Neighborhood does not discriminate on the basis of handicapped status, race, gender, religion, or ethnic background.
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