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EBCHC Preliminary Application for Affordable Rental Program
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Steps
1.
Applicant Information
This section is complete
This section is incomplete
2.
Household information
This section is complete
This section is incomplete
3.
Current Living Situation
This section is complete
This section is incomplete
Applicant Information
Only those people listed on the application and lease are allowed to live in the unit. Income is re-certified on an annual basis prior to lease renewal and current limits will apply. Pets are not allowed except for service animals.
Applicant Name
*
Full name of the primary applicant
Email Address
Telephone Number
*
Street Address
*
State
*
City
*
Zip Code
*
Adults in household
*
-- Select One --
1
2
3
4
5
6
7
Children in household
*
-- Select One --
0
1
2
3
4
5
6
Desired Number of Bedrooms
*
1
2
3
All bedrooms must be used as a bedroom by an occupant; no dens, studies, or guest rooms are allowed.
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Household information
Fill out the following information for each person in the household. Sources of income include all income, unemployment, social security, disability, alimony, child support, interest.
Name
*
Relationship to Applicant
Sex
*
female
male
Age
*
Annual Income
*
Source(s) of income
*
Name
Relationship to Applicant
Sex
female
male
Age
Annual Income
Source(s) of income
Name
Relationship to Applicant
Sex
female
male
Age
Annual Income
Source(s) of income
Name
Relationship to Applicant
Sex
female
male
Age
Annual Income
Source(s) of income
Name
Relationship to Applicant
Sex
female
male
Age
Annual Income
Source(s) of income
Name
Relationship to Applicant
Sex
female
male
Age
Annual Income
Source(s) of income
Name
Relationship to Applicant
Sex
female
male
Age
Annual Income
Source(s) of income
Total Annual Household Income
*
Total annual income for all household members.
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Current Living Situation
Current Rent
*
Rent per month
Current household size
Number of bedrooms in current home
Approximate Utility Costs
*
Utility costs per month
Current Living Arrangement
*
Use this section to explain your current living arrangement. Please list any special needs, such as handicap accessibility.
Have you or has a household member been convicted of a felony?
*
-- Select One --
yes
no
What is your approximate credit score?
*
Explain any credit issues.
Will a tenancy check show a pattern of rent deliquency or other problems with a landlord of mortgage holder?
*
Bankruptcy
Eviction
Foreclosure
Not applicable
Explain any rent or home ownership problems.
Occupancy preference
State law authorizes housing occupancy preferences in certain circumstances. Please note if you may qualify (e.g., veteran, disabled, homeless, victim of domestic violence, victim of natural disaster, etc.).
Application Certified to be True
*
-- Select One --
yes
no
I/we certify that if selected to participate in this program, the unit I/we occupy will be my/our only residence. I/we understand that the above information is being collected to determine my/our eligibility. I/we authorize the East Brunswick Community Housing Corporation to verify all information provided on this application and to contact previous or current landlords or other sources of credit and verification information which may be released to appropriate Federal, State, or local agencies. I/we certify that the statements made in this application are true and complete to the best of my/our knowledge and belief. I/we understand that false statements or information will disqualify this application from eligibility and are punishable under Federal Law.
Electronic Signature Agreement
*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Electronic Signature
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
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