OFFICE USE ONLY Unit Size Requested Unit Number Targeted Move-In Date Date Received Time Received _N__o__r_t_h_b__r_i_d_g__e__A__p__a__r_tm___e__n_t_s__________________ _8__0_6___T__r_o_y___R__o_a__d______________________________ _A__l_b_e__r_t__L_e__a__,_M___N___5_6__0__0_7_____________________ _P__h__:_(_5__0__7_)__4__0_2__-_3__3_7__3________________________ APPLICATION FOR OCCUPANCY Incomplete applications will be returned APPLICANT INFORMATION Applicant Name (Head of Household): First Middle Last Address: Street Address City State Zip Social Security Number: Date of Birth: [ ] Male [ ] Female [ ] Decline Applicant Phone #: Applicant Email: Alternate Phone #: Alternate Email: Emergency Contact: Name (Someone outside your household) Phone Email List All Other Household Members First MI Last Relationship to Head Date of Birth Male/Female/ Decline to Answer Social Security Number [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline Primary Language: Do you require an interpreter? [ ] Yes [ ] No How did you hear about this housing? [ ] Online [ ] Newspaper [ ] Local Agency [ ] Drive By [ ] Resident Referral [ ] Other What is the combined gross monthly income of all household members? $ ADDITIONAL HOUSEHOLD MEMBERS CURRENT HOUSING STATUS How long have you lived at your current address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: Do all adult household members live at this address?........................................................................................................................ [ ] Yes [ ] No If NO, include additional adult household’s current address and contact information on a separate piece of paper. PREVIOUS HOUSING STATUS Your previous address: How long did you live at your previous address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: List every state in which each household member has lived: ELIGIBILITY INFORMATION The following questions pertain to yourself and every member of your household who will occupy the unit. Check either Yes or No in response to each question. All questions must be answered; for those questions that do not apply, you are required to indicate so by answering “not applicable” or “n/a”.
