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201109462 ANNUAL STUDENT CERTIFICATION Move in Datee• (MM/DD/YYYY) This Annual Student Certification is being delivered in connection with the undersigned's application/occupancy in the following apartment: Head of Household Name: Unit Number: Building Address: Check A, B, or C, as applicable (note that"student"includes those attending public or private elementary schools, middle or junior high schools, senior high schools, colleges universities, technical, trade, or mechanical schools,but does not include those attending on-the-job training courses): A. Household contains at least one occupant who is not a student and has not been/will not be a student for five ar more months out of the current and/or upcoming calendar year(months need not be consecutive). If this item is checked, no further information is needed. Sign and date below. B. Household contains all students, but is qualified because the following occupant(s) is/are a PART TIME student(s). Verification of part time student status is required for at least one occupant. C. Household contains all FLTLL TIME students for five or more months out of the cui�ent and,`or upcoming calendar year(months need not be consecutive). If this item is checked, questions 1-5, below must be completed: 1. Are the students married and entitled to file a joint tax return? (attach marriage certificate YES NO or tax return) 2. Is at least one student a single parent with child(ren) and this parent is not a dependent of YES NO another individual and the child(ren) is/are not dependent(s) of someone other than a parent? (attach student's most recent tax return or Certification of Dependent Child(ren)) 3. Is at least one student receiving Temporary Assistance to Needy Families (TANF), YES NO formally known as Aid to Families with Dependant Children(AFDC) (provide third party verification) 4. Does at least one student participate in a program receiving assistance under the Job YES NO Training Partnership Act, Workforce Investment Act, or under other similar, federal, state ar local laws? (attach verification of participation) 5. Does the household consist of at least one student who was previously under foster care? YES NO (Provide verification of participation) Full-time student households that are income eligible and satisfy one or more of the above conditions are considered eligible. If questions 1-S are marked NO, or verification does not support the exception indicated, the household is considered an ineligible student household. Under penalty of perjury,Uwe certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s) that providing false representation herein constitutes an act of fraud. False,misleading or incomplete information may result in the ternunation of a lease agreement. All household members age 18 or older must sign and date. Signature (Date) Signature (Date) Signature (Date) Signature (Date) (Updated 12/10)