Signature of Agent / Date and Time Rec’d.
CURRENT ADDRESS
Applicant’s First Middle Initial Last
Name / Phone ( )
Street / Alternate Phone ( )
City / State / Zip Code
List Maiden Name and all other Last Names you have used
Do you Own? / Rent? / Rent Amount $ / Driver’s License #
CURRENT LANDLORD OR MORTGAGE HOLDER
Current Landlord
or Mortgage Holder / Phone ( ) / Dates of Occupancy
from to
Street / City / State / Zip
LIST 2 PRIOR ADDRESSES & LANDLORDS. (IF AT CURRENT ADDRESS LESS THAN 5 YEARS)
Your Prior Address / Rent Amount
$
Name of Landlord / Phone ( ) / Dates of Occupancy
from to
Street / City / State / Zip
Your Prior Address / Rent Amount
$
Name of Landlord / Phone ( ) / Date of Occupancy
from to
Street / City / State / Zip
INCOME INFORMATION
Applicant’s Employer / Phone ( )
Street / City / State / Zip
Estimated
Annual Income / List Income Sources
Other than Employment
LIST ALL PERSONS WHO WILL OCCUPY THE UNIT, INCLUDING YOURSELF
Name / Date of Birth / Soc. Sec # / Disabled / Relationship
Yes No / HEAD
Yes No
Yes No
Yes No
Yes No
Yes No
CREDIT REFERENCES
Name / Name
Address / Address
Phone ( ) / Phone ( )
PERSONAL REFERENCES
Name / NameAddress / Address
Phone ( ) / Phone ( )
ADDITIONAL INFORMATION
Have you ever been convicted of a felony? / Yes No
Have you been convicted of any drug-related crime? / Yes No
Have you been convicted of any crime involving fraud or dishonesty? / Yes No
Have you been convicted of any crime involving violence or weapons? / Yes No
Are you currently charged with any of the above criminal activities? / Yes No
Are you currently subject to a lifetime registration requirement under a state sex offender registration program? / Yes No
List all states in which you have lived or have held licenses to drive. Include driver’s license numbers.
Continue on Page 2
Are you currently using illegal drugs or any other controlled substance that has not been prescribed for you? / Yes NoHave you ever been or are you currently being evicted from your residence? / Yes No
Have you been evicted from a federally assisted site for drug-related criminal activity within the past three years? / Yes No
Are you a United States citizen, national or have eligible immigration status? / Yes No
Are you a Student? / Yes No
Are you currently or have you ever lived in another First Housing Corporation managed development? If “yes,” which one? / Yes No
Are you displaced due to governmental action or by a presidential declared disaster? / Yes No
Are you currently residing in a property where you received a subsidy or housing voucher to assist you in paying your rent? If yes, please list: / Yes No
What size unit are you requesting? Check One: 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom
THE UNDERSIGNED FURTHER REPRESENTS AND WARRANTS THAT ALL STATEMENTS MADE ARE TRUE AND AGREES THAT IF ANY INFORMATION IS FOUND TO BE FALSE OR MISLEADING, THE APPLICATION CAN BE DENIED AND/OR LEASE TERMINATED AT A LATER DATE. THE UNDERSIGNED ALSO AGREES THAT WE HAVE THE RIGHT TO VERIFY ANY AND ALL INFORMATION GIVEN ABOVE WITH THE APPROPRIATE PERSON/AGENCY, INCLUDING A COMPLETE CREDIT AND CRIMINAL REPORT
WE DO NOT ACCEPT CASH. ALL PAYMENTS MUST BE MADE BY CHECK OR MONEY ORDER.
Signature ofApplicant / Date of
Application
First Housing Corporation Managed Property
Office Use OnlyApplicant (s) Qualifies For:
Regular Waiting List
Preference List
Unit Size Required
Barrier-Free Unit
Special Needs Unit
Application Approved Yes No
Rejection Letter Sent
/ Equal Housing Opportunity
Equal Opportunity Employer /
Serenity Place
216 S. Clinton Street
Grand Ledge, MI 48837-2071
517-627-8460
TTY: 800-649-3777
OPTIONAL INFORMATION FOR ALL APPLICANTS
Reasonable Accommodations or Special Needs
First Housing Corporation manages this property and has a legal obligation to provide “reasonable accommodations” to applicants if they or any family member have a disability or handicap.
A reasonable accommodation is some modification or change that can be made to the policies, procedures, or services that will assist an otherwise eligible applicant with a disability to have equal access to participate in the program or necessary to afford applicant full enjoyment of the premises. Reasonable modifications are those that would not place an undue financial burden to the apartment complex. Modification requests will be evaluated individually on a case-by-case basis. Reasonable accommodations may include, but are not limited to, adjustments or modifications to buildings, facilities, dwellings, and may also include provision of auxiliary aids, such as readers, interpreters, and materials in accessible formats.
If you believe your housing needs can best be met through a reasonable accommodation, please check below all that applies to your household. A physician or health care provider must document verification of the disability.
Ground Floor Unit* Unit for Vision Impaired*
A Barrier-Free Apartment* Unit for Hearing Impaired*
One-Level Unit* Bedroom & Bath on First Floor*
Other Modification to Unit* Live-In Aide*
Assistive Animal** Modification to Policy, Procedures or Services*
Need assistance or help in understanding and completing this application
An applicant family that has a member with a disability must still be able to meet the essential obligations of tenancy—they must be able to pay rent, to care for their apartment, to report information to the Manager, avoid disturbing their neighbors, etc.; but there is no requirement that they be able to do these things without assistance.
Signature ofApplicant / Date of
Application
* Applicant must sign the release of information on the Section 504 Accommodation Verification Form (Form #504-A) prior to submitting to the physician or health care provider.
** Applicant must sign the release of information on the Assistive Animal Verification Form (Form #504-B) prior to submitting to the physician or health care provider.
First Housing Corporation Page 2 of 22
Section 8/Tax Credit Serenity Place 12/2012
Rental Application
RESIDENT SELECTION CRITERIA
FIRST HOUSING CORPORATION
Serenity Place
Section 8 Properties
OBJECTIVE
To ensure that all applicants regardless of race, color, religion, sex, marital status, national origin, age, physical or mental handicap and familial status will be treated equally in the application and rental process required for occupancy.
· Family includes but is not limited to the following, regardless of sexual orientation, gender identity or marital status:
1. Sexual Orientation – Homosexuality, Heterosexuality and Bisexuality
2. Gender Identity – actual or perceived gender characteristics.
· Section 504 of the Rehabilitation Act of 1973 prohibits discrimination of the basis of disability in any program or activity receiving federal financial assistance from HUD.
· The Fair Housing Act prohibits discrimination in housing and housing related transactions based on race, color, religion, sex, national origin, disability and familial status.
· Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, or national origin in any program or activity receiving federal financial assistance from HUD.
APPLICATION/OCCUPANCY REQUIREMENTS
All applicants will have a criminal background and sex offender registry search completed for each state that the applicant has had residency. In addition, a credit and landlord reference check will be completed prior to the determination of qualifying for residency.
1. All applicants must be 62 years of age or older, handicapped or disabled in elderly developments.
2 All applicants must have an eligibility income less than or equal to the program’s established income limits and agree to pay the rent required by the program under which the applicant will receive assistance. Income Limits are published annually and are posted in this office and are also available from the local HUD office or on line at www.huduser.org. HUD establishes Income Limits (for low, very low, extremely low incomes) for each county in the country based on the median income of that area. Income limits are based on family size and the annual income the family receives. Acceptable applicable income limit categories for this property are: low, very low and extremely low.
3. The Head of Household and all household members 18 years and older must submit to a criminal check. Any of the following convictions will result in denial of the application:
a. Assault with intent to murder, assault with intent to rob while armed, kidnapping, assault with intent to do great bodily harm, felonious assault, aggravated assault, domestic violence;
b. Breaking and entering and/or attempted breaking and entering;
c. Criminal sexual contact in the first, second, third or fourth degrees, sodomy, gross indecency or assault with intent to commit criminal sexual contact. Housing a known criminal sex offender will also be grounds for termination
d. Manufacturing, delivery, or possession with intent to deliver any controlled substance, manufacturing of controlled substances, possession of any controlled substances or any attempted offense associated with those within the twenty years prior to the date of application;
e. Larceny from a person, armed robbery, larceny from a motor vehicle;
f. Arson or intent to maliciously burn real property;
g. Any firearm offense;
h. Convictions not listed will be evaluated on an individual basis;
i. A record of any felony, including felonies pled down to a misdemeanor for violence will result in automatic denial within 20 years of conviction or parole: whichever is greater.
j. Other criminal activity that threatens the health, safety and right to peaceful enjoyment of the property by other residents or the health and safety of the owner, employees, contractors, subcontractors, or agents of the owner;
k. Eviction from a federally assisted site for drug-related criminal activity within the past three years;
l. Currently subject to a lifetime registration requirement under a state sex offender registration program;
m. Currently charged with a crime involving sex, violence, weapons, drugs, fraud or dishonesty;
n. Any household member is currently engaging in illegal drug use;
o. Management determines 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, (examples of evidence of illegal activities may include a conviction record, former landlord references, etc.);
p. Management determines 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.
q. Records of non-violent misdemeanors will not be considered in the evaluation, with the following exceptions:
A. Records of three alcohol related crimes in the last five years will result in automatic denial.
B. Records of three or more for the same non-violent misdemeanor in the last five years will result in automatic denial.
C. Record of a misdemeanor involving violence of any kind will result in automatic denial within 10 years of conviction or parole: whichever is greater.
4. Screening of State Lifetime Sex Offender Registration: First Housing Corporation has established standards and processes in order to comply with HUD’s regulatory requirements that prevent lifetime sex offenders from receiving federal housing assistance as follows:
a. Households will be asked at admission and at each Annual, Interim, and Initial Certification whether any member is subject to a lifetime registration requirement under a state sex offender registration program
b. All members 18 years of age and older will be processed through the Dru Sjodin National Sex Offender Website to confirm that applicants and federal housing assistance recipient are not lifetime registered sex offenders.
c. Failure to respond to these questions or submission of false information regarding these questions will result in denial of the application and/or termination of tenancy.
d. This property will aggressively pursue termination of tenancy or assistance, as appropriate, for residents subject to a state lifetime sex offender registration requirement to the extent currently allowed by law.
5. The applicant must agree to a credit check and have acceptable credit history as follows:
a. Credit reports will be evaluated based on past credit history using value ratings from 1 (best) to 9 (worst).
b. Any credit report with 3 or more ratings of a 9 over $350.00 or any one account over $750.00 will result in automatic denial. Ten or more ratings of a 9 will result in automatic denial. Delinquent accounts more than five years old will be disregarded in the assessment but only if the more recent credit history is favorable. Medical and student loans will not be considered in the credit evaluation.
c. Exceptions may be granted under special circumstances such as a major illness of a family member or cases involving divorce. Foreclosures will be considered on an individual basis.
6. The applicant must pass written landlord references for the past five years (if applicable) and the rental history must be acceptable.
7. The applicant must have receipts for utilities placed in their name on or before the move-in date.
8. The applicant must be able to furnish the following documents:
a. A government issued Birth Certificate for ALL HOUSEHOLD MEMBERS regardless of age. If the birth certificate fails to identify the Head of Household or the Co-Head of Household as a birth parent, applicant must provide custody/guardianship papers for that child. If applicant claims joint physical custody, joint physical custody papers must be provided. In the event that applicant is unable to provide a Birth Certificate, there are a few alternative methods to provide “proof of age” but only after all efforts to provide a true Birth Certificate have been exhausted. Please contact this office for the list of alternative or acceptable documents. If the applicant cannot supply the original Birth Certificate and supplies one of the alternative documents, the applicant must also certify that the document provided is complete and accurate by completing a First Housing form entitled Acceptable Form of Verification in Lieu of Original Social Security Card and/or Birth Certificate.