Application for Tenancy

St. Timothy’s Tower

425 S. Oleander Avenue

Compton, CA 90220

(310) 638-8251

APPLICATION PACKAGE RECEIPT OF FORMS

This receipt is to certify that I, ______have received copies of each of the documents that are listed below. I further acknowledge that I was informed to read each document carefully and to keep a copy for my reference.

_____1. APPLICATION FOR TENANCY

_____2. HUD – 9887 CONSENT OF INFORMATION

_____3. “THINGS YOU SHOULD KNOW” (HUD INFORMATION SHEET)

_____4. FAIR HOUSING STATEMENT

_____5. RESIDENT SELECTION CRITERIA

_____6. BROCHURE

Received by: ______

Resident/Tenant

Date: ______

********************************************************************************

By my signature below, I certify that I have received all documentation from Resident/Tenant, as listed

below:

ý Proof of Age

ý Social Security Card and/or

Verification of Social Security Number(s)

Received by: ______

Staff Member

Date: ______

APPLICATION FOR TENANCY

Thank you for your interest in our facility. Please help us process
your application by providing all information requested below.
Type/Size of Apartment Wanted: ______Date Wanted:______
APPLICANT FULL NAME: ______
LAST FIRST MIDDLE INITIAL
Date of Birth: ______Present Telephone Number: ______
Present Mailing Address: ______
Employed by: ______
Employer’s Address: ______
Employer’s Telephone: ______Your Position: ______How Long? ______
Name of other Resident(s) living with you: ______
Do you have any pets? ______What type?______
Do you own furniture? ______
Do you own an automobile: ______Make: ______Model: ______Year: ______Color: ______
License Plate no. ______State of Registration: ______
Driver’s License no. ______State issued: ______

Interview Checklist

FAMILY COMPOSITION
Family
Member
Number / NAME / Relationship to
Head of Household / Social Security Number / Birthdate / Full-time Student
YES NO
1 / / /
2 / / /
3 / / /
4 / / /
5 / / /
6 / / /
7 / / /
8 / / /

PREVIOUS RENTAL HISTORY

Previous Resident Address: / City/State: / Zip Code: / Landlord Name: / Landlord Phone: / Lived there
from: to:
1
2
3
4
5

INCOME: ANSWER ALL QUESTIONS COMPLETELY

Income Type: / Receiving
Yes No / Who Receives? / Employer/Source of funds: / Gross Monthly Income:
Employment Wages
Tips/Bonuses
AFDC/TANF
Social Security
SSI
Child Support
General Assistance
Unemployment

ASSETS: ANSWER ALL QUESTIONS COMPLETELY

Asset Ty;e: / Does anyone own?
YES NO / Who
Owns? / Current Value: / Annual Income from Asset? / Account Number: / Where is asset located?
Cash
Checking Account
Savings Account
Cert. of Deposit
Money Market
Stocks
Bonds
Buildings, Mobile Homes, Houses
Antiques, Collectables
IRAs
Other, Specify

1. In the last two (2) years, has anyone in the household sold, traded, or given away any asset from the categories

listed above?Yes/No_____ If yes, explain: ______

2. In the last three (3) years, has anyone in the household been arrested? Yes/No______If yes, explain:

______

3. Is anyone in the household a registered sex offender? Yes/No ______If yes, explain: ______

4. If housed, do you agree to pay the monthly rent, as determined using HUD regulations, on time? ______

WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful

false statements of misrepresentation to any Department or Agency of the U.S.

Government as to any matter within it’s jurisdiction.

I/We certify under penalty of perjury that all information furnished by me/us is true and correct to the best of my/our knowledge.

HEAD OF HOUSEHOLD SIGNATURE:______DATE: ______

OTHER ADULT SIGNATURE: ______DATE: ______

FAIR HOUSING STATEMENT

St. Timothy’s Tower & Manor, Inc. shall not discriminate in the assignment of units against an applicant because of HANDICAP, RACE, SEX, NATIONAL ORIGIN, RELIGION, DISABILITY AND FAMILIAL STATUS, POLITICAL OR OTHER AFFILIATION. Conversely, no preference shall be shown to an applicant because of political affiliation of his/her acquaintance with any public official at the Federal, State, or Local level.

Section 504 of the Rehabilitation Act of 1973 prohibits discrimination on the basis of disability in any program actively receiving Federal financial assistance from HUD. The staff and management of St. Timothy’s Tower & Manor, Inc. will comply with all Federal, State, and Local fair housing and civil rights laws and with equal opportunity requirements.

By signing this form, I certify that I have read and understand the above statement and have been informed of my rights in this matter.

Signed: ______Date: ______

St. Timothy’s Tower

425 S. Oleander Avenue

Compton, CA 90220

(310) 638-8251

REVISED – 8/15/04

RESIDENT SELECTION CRITERIA

I. POLICY ON NON-DISCRIMINATION

With respect to the treatment of applicants, St. Timothy’s Tower Agent will not discriminate against any individual or family because of race, color, creed, national or ethnic origin or ancestry, religion, sex, sexual preference, gender identity, age, disability, handicap, military status, source of income, marital status or presence of children in a household, acquired immune deficiency syndrome (AIDS) or AIDS-related conditions or any other arbitrary basis. No criteria will be applied or information considered pertaining to attribute of behavior that may be imputed by some to a particular group or category. All criteria shall be applied equitable and all information considered on an applicant shall be related solely to the attributes and behavior of individual members of the household as they may affect residency.

II. ELIGIBILITY

Section 8 Assistance is available only to U.S. Citizens, non-citizens with legal immigration status, and "mixed families" (families in which at least one, but not all members are U.S. Citizens). Assistance to mixed families will be prorated. A temporary deferral of terminated assistance will only apply to currently assisted families that have no eligible members and those that qualify only for prorated assistance and choose not to accept the partial assistance. Applicants must disclose social security numbers for all family members at least 6 years of age and older and provide proof of the numbers reported or if no social security number has been assigned, the member must complete a certification that no social security number has been assigned. An applicant may not become a participant in the program unless the applicant submits the required social security number documentation to the owner within 60 days. All non-citizens with legal immigration status will be verified through the Systematic Alien Verification for Entitlements system. The same program rules and regulations for determining eligibility status for section 8 rental assistance apply to everyone.

To be eligible, the household must be a family or a single elderly person, handicapped and or disabled whose income does not exceed the area limits as set by HUD. HUD establishes annual income limits by family size. A family consists of one or two adults and children or dependents, two members of which must be related by blood, marriage, or acts of law.

This is a project-based section 8 program. Only families meeting extremely low and very low income standards are eligible for section 8 assistance in this program. Congress requires that 40% of new admissions to project-based programs be extremely low income. The remaining new admissions may not exceed the very low income limit.

Extremely Low Income = 30% of area median income.

Very Low Income = 50% of area median income.

Low Income = 80% of area median income

HUD Income Limits

Are Published In The Federal Register Each Year.

III. APPLICATION PROCEDURES

Families interested in participating in the project-based section 8 program must complete a preliminary application. The preliminary application is designed to provide the staff with sufficient information to determine if the applicant is eligible.

Completed applications will be reviewed by housing staff. If the staff determines that the applicant is eligible on the basis of income and family composition, the family will be notified in writing and the family's name will be placed on the waiting list according to the time and date of the application. If the family is determined to be ineligible, they will be notified in writing of the reasons for the ineligibility determination.

Due to the income target requirements, the owner will admit only extremely low-income families first until the 40% target is met. In chronological order according to the time and date of the application. The owner will select eligible applicants from the waiting list whose incomes are at or below the extremely low-income limit to fill the first 40% of expected vacancies in the property. Once this target has been reached, the applicants will be place as stated below:

A. Applicants will be added to a waiting list in chronological order and according to the time and date of the application.

B. In the event that the volume of applications received exceeds the number of slots available for the waiting list, all applications will be added to the waiting list in chronological order.

C. When management receives the next 30-day notice, it will be the responsibility of the housing staff to notify the applicant at the top of the waiting list. If that applicant turns down the unit, the housing staff will then proceed to the next person on the waiting list.

D. If an applicant on the waiting list rejects two units offered to him/her, he/she may remain on the list but will then be assigned a new position on the waiting list based on the date the applicant rejected the second unit.

PRIORITY

Only currently housed tenants with extenuating circumstances such as extreme medical emergencies that warrant immediate attention, a court ordered move, due to a terrorist threat or a domestic violence case that results in an arrest will take precedence over the waiting list.

TENANT SCREENING

The housing staff will evaluate prospective tenants using the following factors:

1. History of Responsible Tenancy, Behavior and Conduct

Demonstrated ability to pay the basic rent based on verifiable rental history. Current landlord references will be obtained. Previous landlords during the past five years may also be contacted. Landlord references will help determine rental history including but not limited to non-payment of rent, repeated disruptive behavior, and chronic late rent payments. A determination will be made regarding whether or not the applicant has demonstrated a record of conduct which could constitute a material violation of Washington Townhouses, Villa Yucatan and Northwest Manors I Apartments’ Occupancy Agreement and House Rules provisions or applicable tenancy law. If such a record of violations is documented, that will be considered grounds for a determination of ineligibility. Eviction and Unlawful Detainer, Criminal or Drug related activity within the last five years will be grounds for ineligibility.

2. A credit reference will be required and conducted through the U.D. Registry for all adult household members over eighteen, within five years old. Any outstanding collections, which exceed $2,000.00 (medical expenses and deferred student loans exempt from this standard), are basis for denial of applicant. Foreclosure, bankruptcies, and repossessions within five years are also basis for denial, however, we do understand that exemptions may exist, and these will be evaluated on an individual basis. Applicant will be considered for residency if he/she can prove that he/she has paid for all debt recorded in the report.

3. Criminal background checks will be conducted on all applicants over the age of 18 years old by Pre-employ.com, Inc. After the applicant has satisfied all income and credit reporting. A felony charge may be basis for denial.

4. A home visit report and inspection within a fifteen mile radius will be conducted by the housing staff after the applicant has satisfied all income and credit report requirements.

5. By submitting an application the applicant acknowledges and accepts to abide by the House Rules and Regulations.

REJECTED APPLICATIONS

E. Applications may be rejected for any of the following:

1. Blatant disrespect, disruptive or anti-social behavior toward management, the property, or other residents exhibited by an applicant or family member any time prior to move-in (or demonstrable history of such behavior).

2. An unacceptable landlord or other references, encompassing failure to comply with the lease, poor payment history, poor housekeeping habits or eviction for cause.

3. An unacceptable credit report (any outstanding collections, which exceeds $2,000) medical expenses and deferred student loans are exempt from this standard.

4. An unacceptable eviction report (eviction and unlawful detainer within the last five years).

5. Rent exceeding the applicable income limit.

6. Falsification of any information on the application.

7. Family size that does not conform to the stated minimum and maximum size.

8. An unacceptable home visit (safety and health hazards).

9. An unacceptable Criminal Background report (criminal or drug related felonies or misdemeanors within the last five years).

10. Other good cause, including, but not limited to, failure to meet any of the program qualification or other selection criteria in this document.

11. Any household member has been evicted from a federally assisted site for drug-related criminal activity within the past three years.

12. Any household member is currently engaging in illegal drug use.

13. It's determined that there is “reasonable cause to believe that a household member’s illegal use or a pattern of illegal use of a drug may interfere with the health, safety, or right to peaceful enjoyment of the premises by other residents”.

14. It's determined that there is “reasonable cause to believe that a household member’s abuse or pattern of abuse of alcohol interferes with the health, safety, or right to peaceful enjoyment of the premises by other residents.

15. Any household member subject to a lifetime registration requirement under a state sex offender registration program.

16. Drug-related criminal activity.

17. Violent criminal activity; or

18. Other criminal activity that would threaten the health, safety, or right to peaceful enjoyment of the premises by other residents, or of the site’s employees, contractors, or agents.

Applicants may be rejected for any one of the reasons stated above. If an applicant is rejected, the applicant will be notified in writing.