Thank you for your interest. Attached is a (Tenant Selection Criteria) and the application.
Please feel free to contact us should you have any questions!
“This institution is an equal opportunity provider, and employer.”
TENANT SELECTION CRITERIA: EQUAL HOUSING OPPORTUNITY
1. Income Eligibility
Level: Preference will be given to Very Low Income Applicants (VLIA) and then
VLIA: 1 person Annual Adjusted Gross Income less than: $18,200 $20,150
VLIA : 2 person Annual Adjusted Gross Income less than: $20,800 $23,000
LIA: 1 person Annual Adjusted Gross Income less than $29,100 $32,200
LIA: 2 person Annual Adjusted Gross Income less than: $33,300 $36,800
2. Credit References : Management agent will obtain a credit report. The application fee ($5.00 per adult household member) will be requested at the time of application. Applicant may be rejected for a history of poor credit.
3. A tenant must be of legal age to sign a lease (18 years of age or older or be an emancipated minor).
4. References: Landlord references from all landlords for at least the last three years and three (3) personal references are required.
5. The management agent in its sole discretion will determine from a prospective tenants verified income whether such prospective tenant is financially capable of meeting his or her financial obligations for living expenses pertaining to this apartment complex.
6. Priority will be given to thos displaced from any other Rural Development project due to the prepayment of the loan on the project where the displaced person presently resides and with a (Letter of Priority).
7. No person will be denied occupancy due to race, color, religion, sex, handicap, familial status or national origin. Waiting lists will be maintained with qualified Very Low Income Applicants and Low Income Applicants by chronological order according to application receipt date.
8. The management agent may request any additional information if it feels it is in the best interest of its client. All information received will be handled in a confidential manner.
9. If an applicant refuses an apartment when a vacancy occurs, in cases of emergency the applicant is left on the Waiting List in the position they occupy at that time. In cases of non-emergency, the applicants name is removed from the Waiting List and notified in writing of this action.
10. Applicants may be rejected for: negative landlord, credit or personal references, history of criminal activity and/or untruthful submission of information on any required forms filled out and signed.
11. Occupancy guidelines are as follows:
1-bedroom apartments May be occupied by a total of no more than 2 people
2-bedroom apartments May be occupied by a total of no less than 2 people and no more than 4
3-bedroom apartments May be occupied by a total of no less than 3 people and no more than 6
APPLICATION FORM FOR VERY LOW OR LOW INCOME HOUSING IN R.D. PROJECTS
$5.00 application fee (per adult applicant)
Number of Bedrooms Requested (Please circle): 1 2 3
Are you applying for (Please check): Subsidized only: _____ Basic Rent: _____ Subsidized or basic rent: _____
Are you a smoker?______Yes________No
Last Name: First Name: MI:
Own ______ Rent ______ (if rent) $___________per/mo Time at Residence: Years ______ Months ______
Mailing Address: City: State:
Zip code: Telephone Number: ( )
List all persons who will live in the apartment (List Head of Household first):
NAME RELATIONSHIP BIRTHDATE AGE SOCIAL SECURITY #
H. | | | | - -
2. | | | | - -
3. | | | | - -
4. | | | | - -
5. | | | | - -
6. | | | | - -
Is the Applicant or Co-Applicant a full-time student? Yes ______ No ______
Is the Applicant or Co-Applicant claimed as a dependent on any third partys tax return? Yes ______ No ______
If the answer is yes, you do not qualify to reside in this federally funded property.
Do you own a pet? Yes _____ No _____ If yes, what kind?_________________________________________
Please be aware that pets are not allowed except in the (Elderly) designated properties.
Please answer YES or NO to the following assets. Please list the household member who owns the asset and the location of that asset: If additional space is needed, please attach another page.
Y or N Household Member Location/Bank Current Balance
Checking | | $
Savings | | $
CDs | | $
Stocks or Bonds | | $
IRAs/Retirement Funds | | $ _______
Trust Accounts | | $
Life Insurance | | $
Real Estate | | $
Other Current Assets | | $
Do you own any Real Property (i.e. house or land)? Yes ______ No _______
Location of real property:
Appraised Market Value: $ Mortgage or outstanding loan balance due $
Have you sold or given away any real property in the past two years?
Location of real property: Date of transaction:
Market value when sold/disposed of: $
Amount sold/disposed for: $
“This institution is an equal opportunity provider, and employer.”
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Have you disposed of any other assets in the past two years? Yes ______ No _______
(given money to relatives, set up irrevocable trusts, etc.) If Yes, please describe what happened including the date and the amount given away:
Do you have any other assets not listed above (excluding personal property)? Yes ______ No _______
If YES, please list:
Please answer YES or NO to the following sources of income. Please list the household member who receives the income and where they receive it from (i.e.: Name and address of provider):
Y or N Household Member Monthly Amount Source (employer name/address)
Soc Sec/SSI | | |N/A
Pension | | |
Veteran Benefits | | |N/A
Unemployment | | |N/A
Workers Comp | | |
TANF | | |N/A
Employment | | |
Alimony | | |
Child Support | | |
Military Pay | | |
(friends/family) | | |
Income from assets | | |
Do you receive any income, which is not listed above? Yes ______ No _______
If YES, please list this income on an additional page.
Do you pay for childcare due to work and/or education for any minors under 13 years of age? Yes ______ No _______
If YES, please list: Child Name & Age: | Weekly Cost: $
Child Name & Age: | Weekly Cost: $
Child Name & Age: | Weekly Cost: $
Name and address of Caregiver:
The eligibility for a $400 household deduction and medical cost deduction requires that the applicant or co-applicant be 62 years of age or older, handicap or disabled. Do you meet any of these requirements? Yes ______ No _______
If YES, please provide names and addresses for the following for all household members:
Physician: Monthly Cost: $
Pharmacy: Monthly Cost: $
Medical Insurance: Monthly Cost: $
HANDICAPPED ASSISTANCE EXPENSES:
Complete only if Handicapped expenses allow the handicapped or another household member to work.
Expenses: Weekly Cost: $
Paid to whom:
Do you, or does any member or your household, have a condition that requires:
P A live-in aide (personal care attendant) p Unit for vision-impaired
P A barrier-free apartment p Physical modifications to a typical apartment
P Unit for hearing impaired p Special parking space
If you checked any of the above listed categories of units, please attach an additional sheet of paper explaining exactly what you need to accommodate your situation.
Who should be contacted to verify your need for the features you have identified above (i.e. a doctor or social service agency)? Name: Phone #:
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LANDLORD INFORMATION: Please provide for the past three years.
All periods of time during the 36 months immediately preceding the date of this application must be accounted for.
Name Complete Mailing Address Phone Number Dates of Tenancy
1. | | | to
2. | | | to
3. | | | to
Are you currently under eviction, have you ever been evicted or has a previous landlord started the
eviction process? Yes ______ No _______
This includes receiving a Notice of Termination or a Notice to Quit issued for any reason. If you have received one of these notices, you must indicate, “Yes” even if you moved before the notice expired, before judgment was entered or made an agreement with the landlord. If YES, please explain.
Have you ever violated the terms of previous rental agreements or leases? Yes ______ No _______
This includes, but is not limited to, non-payment or rent or security deposit, leaving before the lease term expired, failing to maintain the apartment in a sanitary condition, damaging the apartment, providing inaccurate information to previous landlords and/or regulatory agencies such as HUD, local Housing Authorities. If YES, please explain.
PERSONAL REFERENCES: Please provide name, complete mailing address & phone # for (3) references.
Family members/relatives cannot be used as a personal reference.
Name (Non-Related) Complete Mailing Address Phone Number
1. | |
2. | |
3. | |
Have you ever been convicted of any illegal behavior or act? Yes ______ No _______
This does not include traffic offenses such as speeding. This also does not include OUI or DWI. Please remember criminal records remain in tact without being erased. If you or any adult member of your household has been convicted of illegal activity within the three years immediately preceding occupancy this application will be rejected. Extreme offenses, including but not limited to sex offenses, arson or homicide, may lead to rejection of the application regardless of when the conviction occurred.
Do you have poor credit references? Yes ______ No _______
A credit report will be obtained. Negative credit may result in the requirement of a cosigner. To be approved, a cosigner must have clean credit and ability to pay should the required payments not be made. Cosigners will be kept until such time as there has been six consecutive months of on-time rental payment.
Have you been truthful in submitting information on this Application? Yes ______ No _______
Do you understand that these questions require information on all members of the household? Yes ______ No _______
Do you understand
that if we discover in the verification process that incorrect information has
Do you understand
that if we discover after you have moved into the complex that incorrect
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By signing my name below, I certify that:
* I will not maintain a separate subsidized rental unit in another location
* I understand that my eligibility for
housing will be based on RD/MSHA/HUD selection criteria and by Fickett
* If accepted for tenancy, this apartment will be my households permanent residence;
* I HAVE NOT left any other federally-subsidized housing units with an outstanding rent or damage payable;
I have answered all of these questions truthfully;
* I understand that if it is
discovered during the verification process that I have not provided accurate
* I understand that if it is
discovered after I move into the complex that I have not provided accurate information;
* This certification is made with full knowledge of the family limitations prescribed by RD for this project.
Applicant Signature Date
Co-Applicant Signature Date
THE FINAL PAGE OF THIS APPLICATION IS A CONSENT FORM. PLEASE BE SURE TO SIGN THE CONSENT FORM SO THAT WE CAN PROCESS YOUR APPLICATION.
Disclosure Statement: This information regarding race, national origin and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Development, Rural Housing Service that Federal Laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, familial status, age and handicap are complied with. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race/national origin and sex of individual applicants on the basis of visual observation and surname.
Ethnicity (National Origin): ___Hispanic or Latino ___Not Hispanic or Latino
Race (mark one or more): ___Caucasian ___African American ___Asian
___American Indian/Alaskan Native ___Native Hawaiian or Other Pacific Islander
Gender: ___Male ___Female
Information Supplied by: __________Applicant (initials) __________Management (initials)
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminated on the basis of race, color, national origin, sex, age or disability. (Not all prohibited bases apply to all programs).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD).
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I authorize and direct any Federal, State or local agency, organization, business or individual to release and verify my application for participation, and/or to maintain my continued assistance under the Section 8, Rental Rehabilitation, Low-Income Public and Indian Housing, and/or other housing assistance programs. I understand and agree that this authorization or the information obtained with its use may be given to and used by the Department of Housing and Urban Development (HUD)/Rural Development (RD) administering and enforcing program rules and policies. I also consent for HUD/RD or the manager to release information from my file about my rental history to credit bureaus, collection agencies, or future landlords. This includes records on my payment history, and any violations of my lease or occupancy policies.
I understand that, depending on program policies and requirements, previous or current information regarding me or member of my household may be needed. Verifications and inquires that may be requested, include but are not limited to:
Identity and Marital Status Employment, Income and Assets
Medical or Child Care Allowances Residence and Rental Activity
Group or Individual that may be asked:
The groups or individuals that may be asked to release the above information (depending on program requirements) include but are not limited to:
Previous Landlords (including Public Housing Agencies) Past & Present Employers
Courts & Law Enforcement State Unemployment Agencies
Schools and Colleges Welfare Agencies
Support and Alimony Providers Veterans Administration
Banks and other Financial Institutions Credit Bureaus
Medical and Child Care Providers Retirement Systems
Utility Companies Credit Providers
I agree that a photocopy of this authorization may be used for the purpose stated above. The original of this authorization is on file in the management office and will stay in effect for a year and one month from the date signed. I understand that I have the right to review my file and correct any information that I can prove is incorrect.
Head of Household Signature Printed Name Date
Co-Applicant Signature Printed Name Date
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