Application for Dunn Memorial Housing

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Helen Murphy
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1 Application for Dunn Memorial Housing KIND OF HOUSING: Affordable one-bedroom apartments for seniors age 55 and older SENIOR APARTMENTS Dunn Memorial Housing, 4805 Baseline Road, Boulder, CO Phone: Fax: units REQUIREMENTS Age 55 or older Must show ability to pay monthly rent monthly income must be three times the amount of the tenant rent or two times if can be verified ability to pay same amount of rent in past with same income level for one year with no late payments. RENT (effective March 01, 2018) Rent is $842 per month Rent includes water, cable, and trash. Rent does not include heat, electric, and phone. Security Deposit is same as one month s rent. (Paid at move-in) AVAILABILITY AND APPLICATION NO IMMEDIATE OR EMERGENCY HOUSING IS AVAILABLE Units are filled through the waiting list only, according to date and time of application. Waiting time varies according to unit availability. Management reserves the right, should the waiting list become too long, to close the waiting list by posting notice at 6240 Smith Rd, Denver, CO Applications taken at Dunn Memorial Housing during posted office hours, or at Housing Management Services (HMS) / Archdiocesan Housing (AH), 6240 Smith Rd, Denver, CO 80216; (phone), (fax); Monday-Friday: 8:00 AM 5:00 PM It is the applicant s responsibility to ensure that their application is complete and to maintain updated information. Applications with invalid information will be removed from the waiting list. Incomplete applications will not be accepted. A tenant rental history of the past two years will be performed. A criminal background check will be required of ALL adult applicants. Applicants must be able to demonstrate ability to maintain their unit in good condition and to meet their monthly rent payments and to abide by the terms of the lease. An applicant must pay a $33.00 money order ($66.00 for two) at the time of screening for a credit, criminal and rental background check. If you have any questions regarding the application process or the screening process, please do not hesitate to call or write with those questions. A copy of the full Tenant Selection Plan and Tenant Screening Criteria is available at Dunn Memorial or at 6240 Smith Rd., Denver, CO, APPLICATION DUNN MEMORIAL HOUSING Page 1 of 5 Revised: 04/30/2018

2 WAITING LIST EXCEPTIONS 1. The City of Boulder affordable housing regulations require that at least 25% of our occupancy consist of tenants with incomes at or below the 50% median income level for Boulder County (three units). This requirement becomes part of the Tenant Selection Criteria whenever our occupancy is below the 50% of Boulder County median income requirement. An applicant who is first on the waiting list may be skipped if his/her income exceeds the 50% income guideline and the building needs to have a household whose income meets the 50% guideline. The applicant who was skipped would continue to remain on the waiting list in the same position he/she was prior to having been skipped. All applicants must still meet all other requirements set forth in the Tenant Selection Criteria. 2. Applicants who need the features of a handicapped accessible unit will receive preference for an open handicapped accessible unit over all other applicants, but that preference does not extend to open nonhandicapped accessible units. Applicants requesting a handicapped accessible apartment will be placed on the waiting list and that need will be verified by their doctor before a unit is ultimately offered if all other selection criteria are satisfactorily met. Applicants can turn down an offer of a unit two (2) times before having their name moved to the end of the waiting list. After the applicant has turned down the second (2 nd ) offer, their name will be placed at the bottom of the waiting list. If an applicant is continually unable to move after being offered a unit the third (3 rd ) time, their name will be removed completely from the waiting list and would need to re-submit a new application. 3. Applicants who do not respond within a two-week period to inquiries about their interest in remaining on the waiting list will be dropped from the waiting list and must reapply. At the date and time the new, completed application is received, the applicant will be put back on the waiting list in the order of the date and time the application is received. GENERAL INFORMATION Our Dunn Memorial Community is Smoke-Free in the Common Areas and the Apartment Home Units. APPLICATION DUNN MEMORIAL HOUSING Page 2 of 5 Revised: 04/30/2018

3 Application for Housing through Housing Management Services Office Use Only: Date Application Received Time Application Received Initials How did you learn about us? Have you lived at any Archdiocesan Housing locations before? Yes No If yes, where? Please put me on the waiting list for Dunn Memorial 1 bedroom Number of people moving into the apartment: Year you moved out Do you require a handicapped-accessible unit? Yes No (Procedures for verification of mobility impairment must be followed) Is any member of the household a registered life time sex offender in any state? Yes No If yes, please indicate which household member(s): Has any member of the household been convicted of a felony? Yes No If yes, please indicate which household member(s): List all the states where each household member has ever lived: Applicant A Last Name: First Name: Applicant B Last Name First Name: Street Apt Street Apt City State ZIP City State ZIP Social Security #: Social Security #: Date of Birth: / / Date of Birth: / / Month Day Year Month Day Year PAST TWO YEARS OF LANDLORD REFERENCES WITH ADDRESSES Current Landlord Previous Landlord Rental dates: From To Rental dates: From To Landlord Name: Landlord Name: By signing below, I give permission to Housing Management Services to run a background check on my credit history, run a background check on my criminal history, verify my employment, and verify my landlord references. Applicant A signature Date Applicant B signature Date APPLICATION DUNN MEMORIAL HOUSING Page 3 of 5 Revised: 04/30/2018

4 PERSONS to reside in apartment Name Relationship Birthdate Gender Race * HOH Ethnicity ** * Race = 1 American Indian or Alaska Native, 2 Asian, 3 Black or African American, 4 Native Hawaiian or Other Pacific Islander, 5 White, 6 Other, 7 Decline to Report (enter all that apply) **Ethnicity = A Hispanic or Latino, B Not-Hispanic or Latino, C Decline to Report (enter only one) SOURCES OF INCOME (You will need verification of these at the time of move-in certification) Name Social Security SSI Pension OAP Veteran s Benefits Interest/ Dividends Other Total amount of gross monthly income: Total amount of gross annual income: $ $ ASSETS (current value) You will need verification of these at the time of move-in certification) Name OTHER CONSIDERATIONS Property Value Checking Acct. Savings Acct. Trust CDs Stocks/ Bonds If accepted, when could you move in? Right away? 30 days? Other Because Housing Management Services/Archdiocesan Housing homes are independent living communities, are you able to care for your normal personal needs and unit either by yourself or with assistance you have arranged on your own? (This includes bathing, cooking, shopping, doing laundry, taking medications, and housekeeping.) Other Yes No Housing Management Services/Archdiocesan Housing is a fair housing provider and we adhere to all Federal, State and local laws regarding non-discrimination as well as complying with requirements of Section 504 of the Rehabilitation Act of Giving fraudulent information will invalidate this application and the applicant(s) will be denied housing. I acknowledge that I have not given any misinformation in this application. Applicant A signature Date Applicant B signature Date APPLICATION DUNN MEMORIAL HOUSING Page 4 of 5 Revised: 04/30/2018

5 Dunn Memorial Housing 4805 Baseline Road Boulder, CO Tenant Release and Consent I/We, the undersigned hereby authorize to release without liability, (employer or other source) information regarding my/our employment, income, and/or assets to Dunn Memorial Housing (owner or agent) for purposes of verifying information provided as part of my/our apartment rental application. Information Covered I/We understand that previous or current information regarding me/us may be needed. Verifications and inquiries that may be requested include, but are not limited to: personal identity; employment, income, and assets; medical or child care allowances. I/We understand that this authorization cannot be used to obtain any information about me/us that is not pertinent to my eligibility for and continued participation as a Qualified Tenant. Groups or Individuals That May be Asked The groups or individuals that may be asked to release the above information include, but are not limited to: Past and Present Employers Support and Alimony Providers State Unemployment Agencies Medical and Child Care Providers Retirement Systems Conditions Previous Landlords (including Public Housing Agencies) Welfare Agencies Social Security Administration Veterans Administration Banks and other Financial Institutions I/We agree that a photocopy of this authorization may be used for the purposes stated above. The original of this authorization is on file and will stay in effect for the duration of our tenancy. I/We understand I/We have a right to review this file and correct any information that I/we can prove is incorrect. Signatures Head of Household (Print Name) Date Spouse (Print Name) Date Adult Member (Print Name) Date Adult Member (Print Name) Date Note: This general consent may not be used to request a copy of a tax return. If a copy of a tax return is needed, IRS Form 4506, Request for Copy of Tax Form, must be prepared and signed separately. APPLICATION DUNN MEMORIAL HOUSING Page 5 of 5 Revised: 04/30/2018

CLUB COURT APARTMENTS RESIDENT SELECTION CRITERIA

CLUB COURT APARTMENTS RESIDENT SELECTION CRITERIA 1. Anyone requesting an application is given one. When completed and returned, the application is dated and the time is noted in the upper right corner