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201109462 RENTAL APPLICATION Property Name: Date: Apartment Size Desired: Number of Bedrooms 1. FAMILY DATA: Name of Head of Household Head) S ouse Name(if livin with the household Current Address: Street Ci State Zi Da Phone Night Phone Have you ever used another name? (Y/N) If so,please indicate name PLEASE ANS{i'ER ALL QUESTIONS! Do not[eave any space blank,write"No or N/A"where appropriate. White-out is not acceptable. PLEASE PRiN'I'. Directions to Applicant: Please complete the table below for each member of your household,whether or not those members are related. Include all members who you anticipate will live with you at least 50%of the time during the next 12 months. (A full time student is anyone who is enrolled for at least five calendar months during this taxable year for the number of hours or courses which are considered full-time attendance by that institution. The five months need not be consecutive). If you need additional space for answers to any paragraph listed below,attach additi:;nal sheets and make sure you include a reference to tiie paragraph number,your name and your social security number. 2. HOUSEHOLD COMPOSITION: Member Relation Date of Gender Social Student If Yes,PT Number Name(s) to Head Birth (M/F) Securit # (Y/N or FT 1• HEAD 2. 3. 4. 5. 6. Do all of the above household members reside in the household 100%of the time?(Y/N) If no,please list the household members that do not live in the household 100%of the time: Anticipated changes in the household size within the next 12 months? (Y/N) If Yes,explain Anticipated change in number of students within the next 12 months? (Y/N) If Yes,explain Current Marital Status: Single Married Divorced Separated Widowed Are all occupants full time students?Yes_ No_ If Yes,please answer the following: a.) Are any of the students married and entitled to file a joint Federal income Tax Retum with their spouse? Yes No (If Yes,attach a copy of the Signed Federal Income Tax Return). b.) Are any of the students receiving assistance under Title IV of the Social Security Act,which includes but is not limited TANF/AFDC? Yes No c.) Are any of the students enrolled in a job training program receiving assistance under the Workforce Investment Act(WIA)/Job Training Partnership Act(JTPA)of under similar Federal,State or local laws?Yes No_ d•) Does the household consist of single-parent(s)and their child(ren)and such parent(s)are not dependents on another individual tax return and such children are not dependents of another individual other than a parent of such child? 1'es No_ (If Yes,and all household members are full time students,a signed copy of your Tax Retum and Divorce Decree must be attached). e.) Does the household consist of at least one student who was previously lmder foster care? Yes No_