Rental Application for Residents and...

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Rental Application for Residents and Occupants TEXAS APARTMET ASSOCIATION Each co-resident and each occupant over 18 must submit a separate Application. M E M B E R Date when filled out: ___ __ ABOUTYOU Full name (exactly as it appears on driver license or govt. ID card) Former name (if applicable)----------- -------------------------- Gender__________ Birthdate __________ Social Security# ______________ _ Driver license# _____________________ _________ State _ _______ _ Government ID# _____________________ ___ _ State (if applicable) _ _______ _ Home phone ________________ _ _ Cell phone __________ ________ _ Work phone Email address __________________ _ Marital status single married U.S. citizen? yes no Do you or does any occupant smoke? yes no I am applying for the apartment located at � 6 1 = 3 0 �------------------- - - ls there another co-applicant? yes no Co-applicant name _______________________ E mail _________ _____ _ Co-applicant name Email _ _ _ ___________ _ Co-applicant name Email ______________ _ Co-applicant name Email _______________ _ OTHER OCCUPANTS Full name Relationship Birthdate Social Security# Driver license# State Government ID# State (if applicable) Full name Relationship Birthdate SociaI Security# Driver license# State Government ID# State (if applicable) Full name Relationship Birthdate Social Security# Driver license# State Government ID# State (if applicable) Full name Relationship Birthdate Social Security# Driver license# State Government ID# State (if applicable) WHERE YOU LIVE Current home address (where you live now)----------------------- --------- City _____________________ ___ _ State__________ Z ip ______ _ Do you rent or own? Beginning date of residency: Monthly pa y ment$ ______ _ Apartment name---------------------------- -- ----------- Name of owner or manager ______________________ _______________ _ Phone___________ Reason for leaving _____ _____________________ _ Previous home address (most recent) --------------------- ------------- City _________________ _ _ _ _____ State __________ Zip _______ _ Do you rent or own? Dates: From _________ To ____ _ _ ___ Monthly pa y ment$ ______ _ Apartment name-- - -------------------- ---------------- - Name of owner or manager __ ___ __________________ ____________ _ Phone_____________ Reason for leaving _______________ _ _ _ _______ _ YOURWORK Current employer ____________ ___ _______________ __________ _ Address ___________ ____ ______________ _________ _ __ _ City _ _ _ _ ____________ _ _ ______ State _ _ _ _ _____ Z i p _ ___ _ _ Work phone __________ Beginnin g date of employment __ ___________ ______ _ ©2017 TEXAS APARTMENT ASSOCIATION, INC. PAGE 1 OF 4 ______

Transcript of Rental Application for Residents and...

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Rental Application for Residents and Occupants TEXAS APARTMEl\:T ASSOCIATION Each co-resident and each occupant over 18 must submit a separate Application.

M E M B E R

Date when filled out: ___ __

ABOUTYOU

Full name (exactly as it appears on driver license or govt. ID card)

Former name (if applicable)------ - - - - - ---------------------------

Gender __________ Birthdate __________ Social Security# _ _ _ _ _ _ _ _ _ _ _____ _

Driver license# _____________________ __ _ _ _ _ _ _ _ _ State _ ________ _

Government ID# _____________________ _ _ _ __ State (if applicable) _ _ _ _ _ _ _ _ _

Home phone ________________ _ __ Cell phone __________ _________ _

Work phone Email address __________________ _

Marital status □ single □ married U.S. citizen? □ yes □ no Do you or does any occupant smoke? □ yes □ no

I am applying for the apartment located at �6�1=3�0�=I=n=.;:gocr=am=�R=o�a=d�------------------- -- -­

ls there another co-applicant? □ yes □ no

Co-applicant name _______________________ Email _________ __ _ _ _ _ _

Co-applicant name Email _ _ _ ____________ _

Co-applicant name Email ______________ __

Co-applicant name Email _______________ _

OTHER OCCUPANTS

Full name Relationship

Birthdate Social Security#

Driver license# State

Government ID# State (if applicable)

Full name Relationship

Birthdate Socia I Security #

Driver license # State

Government ID # State (if applicable)

Full name Relationship

Birthdate Social Security#

Driver license # State

Government ID # State (if applicable)

Full name Relationship

Birthdate Social Security#

Driver license # State

Government ID# State (if applicable)

WHERE YOU LIVE

Current home address (where you live now)-------------------- - - - ----------

City _____________________ __ _ _ _ State __________ Zip ______ __

Do you □ rent or □ own? Beginning date of residency: Monthly payment$ ______ _

Apartment name---------------------- - - - - - - --- ------------

Name of owner or manager _______________ _ _ _ _ _ _ _ ________________ _

Phone ___________ Reason for leaving _ _ _ _ _ ____________________ _ _ _

Previous home address (most recent) -------------- - - - - - - - --------------

City _________________ _ _ _ ______ State __________ Zip _ _ _ _ _ _ _ _

Do you □ rent or □ own? Dates: From _________ To ____ _ _ ____ Monthly payment$ ______ _

Apartment name-- - ------------------ - - - ----------------- --

Name of owner or manager __ _ _ _ ______________ _ _ _ _ _ _____________ __

Phone _____________ Reason for leaving _______________ _ _ _ ________ _

YOURWORK

Current employer ____________ _ _ _ _____________ _ _ _ ___________ _

Address ___________ _ _ _ _ ____________ _ _ _ __________ __ ___ _

City _ _ _ _ _____________ _ _ _______ State _ _ _ _ ______ Zip _ __ _ _ __ _

Work phone __________ Beginning date of employment __ ____________ _______ _

©2017 TEXAS APARTMENT ASSOCIATION, INC. PAGE 1 OF 4

______

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YOUR WORK, continued

Gross monthly income S Position

Supervisor Phone

Previous employer (most recent)

Address

City State Zip

Work phone Dates: From To

Gross monthly income S Position

Supervisor Phone

ADDITIONAL INCOME

(Income must be verified to be considered.)

Type ________________ Source _____________ Gross monthly amount$ __ _ _ __

Type ________________ Source _____________ Gross monthly amount$ _____ _

CREDIT HISTORY

If applicable, please explain any past credit problem: ____________________________ _

RENTAL AND CRIMINAL HISTORY

Check only if applicable.

Have you or any occupant listed in this Application ever: □ been evicted or asked to move out? □ moved out of a dwelling before the end of the lease term without the owner's consent? □ declared bankruptcy? □ been sued for rent? □ been sued for property damage? □ been convicted or received probation (other than deferred adjudication) for a felony or sex crime?

Please indicate below the year, location, and type of each felony or sex crime for which you were convicted or received probation. We may need to discuss more facts before making a decision. You represent the answer is "no" to any item not checked above.

HOW DID YOU FIND US?

□ Online search (website address) _______________________________ _ _ ____

□ Referral from a person or locator? Name ----- ----------------------------

□ Social media (please be specific) ------- - - - - - - - - - -------------------

□ Other ___________________________ _ _ _ _ _ _ ____________

EMERGENCY CONTACT

Emergency contact person over 18 who will not be living with you:

Name _____ _ _ ___ _ _________________ Relationship ____________ _

Address __________________ _ _ _ _ _ _ _ _ __________________ _

City _ _ _ ______________________ State __________ Zip _______ _

Home Phone Cell Phone ________________ _ _ __

Work Phone ____________________ Email Address ______________ ___ __

If you die or are seriously ill, missing, or incarcerated according to an affidavit of (check one or more) □ the above person, □ your spouse, or □ your parent or child, we may allow such person(s) to enter your dwelling to remove all contents, as well as your property in the mail­box, storerooms, and common areas. If no box is checked, any of the above are authorized at our option. If you are seriously ill or injured, you authorize us to call EMS or send for an ambulance at your expense. We're not legally obligated to do so.

YOUR VEHICLES (lfapplicable}

List all vehicles owned or operated by you or any occupants (including cars, trucks, motorcycles, trailers, etc.)

Make Model Color

Year License# State

Make Model Color

Year License# State

Make Model Color

Year License# State

Make Model Color

Year License# State

©2017 TEXAS APARTMENT ASSOCIATION, INC. PAGE 2 OF 4

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YOUR ANIMALS (if applicable)

You may not have any animal in your unit without management's prior authorization in writing. If we allow your requested animal, you must sign a separate animal addendum, which may require additional deposits, rents, fees or other charges.

Kind _______________________________ Weight _ ___________ _

Breed ______________________________ Age _____________ _

Kind _______________________________ Weight ____ ________ _

Breed ______________________________ Age _____________ _

Application Agreement

The following Application Agreement will be signed by you and all co-applicants prior to signing a Lease. While some of the information below may not yet apply to your situation, there are some provisions that may become applicable prior to signing a Lease. In order to continue with this Application, you'll need to review the Application Agreement carefully and acknowledge that you accept the terms.

1. Apartment Lease information. The Lease contemplated by the parties will be the current TAA Lease. Special information and conditions must be explicitly noted on the Lease.

2. Approval when Lease is signed in advance. If you and all co-applicants have already signed the Lease when we approve the Application, our representative will notify you (or one of you if there are co-applicants) of our approval, sign the Lease, and thencredit the application deposit of all applicants toward the required security deposit.

3. Approval when Lease isn't yet signed. If you and all co-applicants have not signed the Lease when we approve the Applica­tion, our representative will notify you (or one of you if there are co-applicants) of the approval, sign the Lease when you and allco-applicants have signed, and then credit the application deposit of all applicants toward the required security deposit.

4. If you fail to sign Lease after approval. Unless we authorize otherwise in writing, you and all co-applicants must sign the Leasewithin 3 days after we give you our approval in person or by telephone or within 5 days after we mail you our approval. If youor any co-applicant fails to sign as required your Application will be deemed withdrawn, and we may keep the applicationdeposit as liquidated damages, and terminate all further obligations under this Agreement.

5. If you withdraw before approval. If you or any co-applicant withdraws an Application or notifies us that you've changed your mind about renting the dwelling unit, we'll be entitled to retain all application deposits as liquidated damages, and the parties will then have no further obligation to each other.

6. Approval/non-approval. If we do not approve your Application within 7 days after the date we received a completed Applica­tion, your Application will be considered "disapproved:' Notification may be in person or by mail or telephone unless you haverequested that notification be by mail. You must not assume approval until you receive actual notice of approval. The 7-day timeperiod may be changed only by separate written agreement.

7. Refund after non-approval. If you or any co-applicant is disapproved or deemed disapproved under Paragraph 6, we'll refundall application deposits within 30 days of such disapproval. Refund checks may be made payable to all co-applicants and mailedto one applicant.

8. Extension of deadlines. If the deadline for approving or refunding under paragraphs 6 or 7 falls on a Saturday, Sunday, or a state or federal holiday, the deadline will be extended to the end of the next business day.

9. Keys or access devices. We'll furnish keys and/or access devices only after: (1) all parties have signed the Lease and other rentaldocuments referred to in the Lease; and (2) all applicable rents and security deposits have been paid in full.

10. Application submission. Submission of an Application does not guarantee approval or acceptance. It does not bind us to ac­cept the applicant or to sign a Lease. Images on our website may represent a sample of a unit and may not reflect specific detailsof any unit. For information not found on our website regarding unit availability, unit characteristics, pricing or other questions,please call or visit our office.

11. Notice to or from co-applicants. Any notice we give you or your co-applicant is considered notice to all co-applicants; and anynotice from you or your co-applicants is considered notice from all co-applicants.

Disclosures

1. Application fee (non-refundable). You agree to pay to our representative the non-refundable application fee in the amountindicated in paragraph 3. Payment of the application fee does not guarantee that your Application will be accepted. The applica­tion fee offsets the cost of screening an applicant for acceptance.

2. Application deposit (may or may not be refundable). In addition to any application fees, you agree to pay to our representa­tive an application deposit in the amount indicated in paragraph 3. The application deposit is not a security deposit. The applica­tion deposit will be credited toward the required security deposit when the Lease has been signed by all parties; OR, it will berefunded under paragraph 7 if the applicant is not approved; OR it will be retained by us as liquidated damages if you fail to signor withdraw under paragraphs 4 and 5 of the Application Agreement.

3. Fees due. Your Application will not be processed until we receive your completed Application (and the completed Applicationof all co-applicants, if applicable) and the following fees:

A. Application fee (non-refundable): $ ______ _B. Application deposit (may or may not be refundable) $ ______ _

4. Completed Application. Your Application will not be considered "complete" and will not be processed until we receive the following documentation and fees:

A. Your completed Application;B. Completed Applications for each co-applicant (if applicable);C. Application fees for all applicants; D. Application deposit.

Authorization and Acknowledgment

I authorize Hill top Oaks

(name of owner/agent) to obtain reports from any consumer or criminal record reporting agencies before, during, and after residency on mat­ters relating to a lease by the above owner to me and to verify, by all available means, the information in this Application, including criminal back­ground information, income history and other information reported by employer(s) to any state employment security agency. Work history in­formation may be used only for this Application. Authority to obtain work history information expires 365 days from the date of this Application.

(02017 TEXAS APARTMENT ASSOCIATION, INC. PAGE 3 OF 4

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Payment Authorization

I authorize Hi11 top Oaks

{name of owner/agent) to collect payment of the application fee and application deposit in the amounts specified under paragraph 3 of the Disclosures.

Non-sufficient funds and dishonored payments. If a check from an applicant is returned to us by a bank or other entity for any reason, if any credit card or debit card payment from applicant to us is rejected, or if we are unable, through no fault of our own or our bank, to successfully process any ACH debit, credit card, or debit card transaction, then:

1. Applicant shall pay a charge of$ 33. 00 for each returned payment; and 2. We reserve the right to refer the matter for criminal prosecution.

Acknowledgment

You declare that all your statements in this Application are true and complete. Applicant's submission of this Application, including pay­

ment of any fees and deposits, is being done only after applicant has fully investigated, to its satisfaction, those facts which applicant

deems material and necessary to the decision to apply for a rental unit. You authorize us to verify your information through any means, including consumer-reporting agencies and other rental-housing owners. You acknowledge that you had an opportunity to review our rental-selection criteria, which include reasons your Application may be denied, such as criminal history, credit history, current in­come and rental history. You understand that if you do not meet our rental-selection criteria or if you fail to answer any question or

give false information, we may reject the Application, retain all application fees as liquidated damages for our time and expense, and

terminate your right of occupancy. Giving false information is a serious criminal offense. In lawsuits relating to the Application or Lease, the prevailing party may recover from the non-prevailing party all attorney's fees and litigation costs. We may at any time furnish information to consumer-reporting agencies and other rental-housing owners regarding your performance of your legal obligations, including both favorable and unfavorable information about your compliance with the Lease, the rules, and financial obligations. Fax or electronic signatures are legally binding. You acknowledge that our privacy policy is available to you.

Right to review the Lease. Before you submit an Application or pay any fees or deposits, you have the right to review the Application and Lease, as well as any community rules or policies we have. You may also consult an attorney. These documents are binding legal documents when signed. We will not take a particular dwelling off the market until we receive a completed Application and any other required informa­tion or monies to rent that dwelling. Additional provisions or changes may be made in the Lease if agreed to in writing by all parties. You are entitled to a copy of the Lease after it is fully signed.

Images on our website may represent a sample of a unit and may not reflect specific details of any unit. For information not found on our web­site regarding availability, unit characteristics or other questions, please call or visit our office.

This Application and the Lease are binding documents when signed. Before submitting an Application or signing a Lease, you may take

a copy of these documents to review and/or consult an attorney. Additional provisions or changes may be made in the Lease if agreed to in writing by all parties.

Applicant's signature Date

FOR OFFICE USE ONLY

1. Apt name or dwelling address (street, city): ___________ __ _ _ _ _________ Unit# or type: _____ _ _ _

2. Person accepting application:________ _ _ _ _ _ _ _ ______________ Phone: 3. Person processing application: ___ _ _ _ _ ________________ _ _ _ __ Phone: 4. Date that the applicant or co-applicant was notified □ by telephone, □ by letter, □ by email, or □ in person of □ acceptance or □nonacceptance: __ __ ___ _

(Deadline for applicant and all co-applicants to sign lease is three days after notification of acceptance in person or by telephone, five days if by mail.) 5. Name of person or persons notified (if there are more than one applicant, at least one of them must be notified): _______________ _ _ _ _ 6. Name of owner's representative who notified the applicant:----- - - - - --------------- - - - - - -----

Additional comments: --------- - - - ----------------- - - - - ------------

TAA Official Statewide Form 17-D1/D2, Revised October 2017 (i? Copyright 2017, Texas Apartment Association -

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Student Status

! Full-time ! Part-time ! N/A

! Full-time ! Part-time ! N/A

! Full-time ! Part-time ! N/A

! Full-time ! Part-time ! N/A

! Full-time ! Part-time ! N/A

! Full-time ! Part-time ! N/A

Number of Persons

1 (Head of Household)

2

3

4

5

6

AgeRelationshipFull Name

6. Rental Assistance. Do you receive any type of federal, state, or local government rental assistance? ! Yes ! No. If yes, please explain: __________________ __________________________________________________________________________________________________________________________________

7. Asset Verification. Have you disposed of any assets for less than fair market value in the last two years preceding the date of this application? ! Yes ! No. 8. Certification. By signing this Supplemental Rental Application, you as the applicant are certifying that all the above information is true and correct. You are

consenting to disclosure of income and financial information from your employer(s) and any financial institutions where your assets are kept.

9. Recertification. If this form is being used for recertification and you have changed employment during the past year, you must complete the “Your Work” sec-tion of the TAA Rental Application.

Applicant Date of Signing Application

__________________________________________________________ _______________________________________________________

Co-Applicant Date of Signing Application

__________________________________________________________ _______________________________________________________

TAA Official Statewide Form 17-W, October, 2017

Copyright 2017, Texas Apartment Association, Inc.

1. Supplemental Information. The purpose of this Supplemental Rental Application is to determine whether you qualify for affordable rental housing under a government regulated affordable housing program. It is very important that you answer all questions fully and accurately.

2. Employment Update. Present employer: _____________________________________________________________________________________________ Address: ______________________________________________________________________ City, State, ZIP: _____________________________________ Work Phone: _____________________________________ Position: _______________________________________________________________________

3. Household Composition. List all persons, including yourself, who will be living in your household.

Does anyone live with you now who is not listed above? ! Yes ! No. Does anyone plan to live with you in the future who is not listed above? ! Yes ! No. If you answered “Yes” to any question, please explain: _____________________________________________________________________________________

_________________________________________________________________________________________________________________________________

Are any of the household members listed above: Foster children? ! Yes ! No Live-in attendants? ! Yes ! No

Were any of the names listed above students in the year this application was completed? ! Yes ! No. Do any of them plan to be students in the year this application is completed? ! Yes ! No. If you answered “Yes” to either question, please explain: _________________________________________________

_________________________________________________________________________________________________________________________________

4. Income. List all income of all adults and persons in your household, including those under 18 (except for income earned from employment by persons under the age of 18 who are dependents of another household member).

$

$

$

$

$

$

$

$

$

$

$

$

$

$$$

$

$

$

5. Assets. List all assets of all adults and persons in your household, including those under the age of 18.

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Annual Interest, Dividends or Rent

from AssetsListing of All Assets Cash ValueName of Financial Institution

or Description of Asset Account Number

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Checking Account(s) ! Yes ! No

Savings Account(s) ! Yes ! No

Credit Union Account(s) ! Yes ! No

Stocks, Bonds orMutual Funds ! Yes ! No

Real Estate or Home ! Yes ! No

IRA/Keough Account ! Yes ! No

Retirement Fund ! Yes ! No (401(k), 457, 403(b), etc.)

Pension Fund ! Yes ! No

Trust Fund ! Yes ! No

Mortgage Note Held ! Yes ! No

Whole Life Insurance ! Yes ! No

Cash Value

Other: ! Yes ! No (explain)

Gross Monthly Income Source: Indicate whether anyone in

your household receives income from the following TotalApplicant Co-Applicant

$

$

$

$

$

$

$

$

$

$

$

$

$

$$$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$$$

$

$

$

TOTAL $

Other Household Members

Supplemental Rental Application for UnitsUnder Government RegulatedAffordable Housing Programs

Date when filled out: _________________________

M E M B E R

$

$

$

$

$

$

$

$

$

$

$

$

$

$$$

$

$

$

Salary ! Yes ! No

Overtime Pay ! Yes ! No

Commissions and Fees ! Yes ! No

Tips and Bonuses ! Yes ! No

Interest and/or Dividends ! Yes ! No

Net Income from Business ! Yes ! No

Net Rental Income ! Yes ! No

Social Security, Supplemental ! Yes ! NoSecurity Income

Pensions, Retirement Funds, etc. ! Yes ! No

Support from Parents or Relatives ! Yes ! No

Unemployment Benefits ! Yes ! No

Workers’ Compensation, etc. ! Yes ! No

Alimony ! Yes ! No

Sources of Child Support:• Court-ordered (regardless if paid) ! Yes ! No• Voluntary payments ! Yes ! No• Anticipated payments ! Yes ! No

AFDC/TANF ! Yes ! No

Student Financial Assistance ! Yes ! No

Other: ! Yes ! No (explain)

01/08/2018

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• UNITED APARTMENT ---LR.OU!' __ _

Tenant Selection Plan Hilltop Oaks Apartments

Hilltop Oaks Apartments and United Apartment Group is committed to compliance with all federal, state and local fair housing laws and will screen all applicants uniformly, including the Texas and Federal Fair Housing Acts and antidiscrimination laws, the Federal Fair Credit Reporting Act, program guidelines, and the Department's rules, and consideration for reasonable accomadations requested to complete the application process .. It is our policy to offer apartment for rental to the general public without regard to race, color, national origin, religion, sex, familial status, handicap or any other state or locally protected classification. Maximum rent and maximum income are adhered to as required by the Texas Department of Housing and Community Affairs (TDHCA) LIHTC Program. All applicants and co-applicants must be 18 and over unless protected by the familial status per the Fair Housing amendment. All adult members of the household must complete a Rental Application and each applicant must pay the application fee at the time of application submission. Third party written verification may be obtained to certify household claim.

United Apartment Group (UAG) uses verifiable information provided by an applicant and Leasing Desk Screening program to determine whether an applicant qualifies and what if any conditions may apply. Our Rental Criteria complies with state and federal fair housing and antidiscrimination laws, is applied uniformly (rental, credit, and/or criminal history), including employment policies, and in a manner consistent with its state's and Federal Fair Housing Acts, program guidelines, and the Department's rules, is reasonably related to program eligibility and the applicant's ability to perform the obligations of the lease. UAG requires all applicants to meet the following criteria in order to qualify for housing at our community. Please note that these are the current rental criteria and nothing in these requirements shall constitute a guarantee or representation by our community that all residents and occupants currently residing in our community have met these requirements. There may be residents and occupants that have resided here prior to these requirements going into effect. Additionally, our ability to verify whether these requirements arc met is limited to the information we received from various applicant reporting services.

In accordance with the Violence Against Women Reauthorization Act (VA WA) of 2013, this property will not deny admission, deny lease renewal, or evict on the basis that the applicant has been a victim(s) of domestic violence, dating violence, sexual assault or stalking.

If this Development is under the HOME Program, we will also do the following: (1) Provide any rejected applicant written notification of the grounds for rejection within thirty (30) days; and (2) Maintain a written waiting list and select tenants from the waiting list in chronological order, insofar as is practicable.

Non-renewal and/or Termination Notices: UAG maintains a written policy regarding procedures for providing households non-renewal and termination notices. We provide in any non­renewal or termination notice, a specific reason for the termination or non-renewal. The notification is then delivered as required under applicable program rules and includes information on rights under VA WA and how a person with a disability may request a reasonable accommodation in relation to such notice. The notification will also include information on the appeals process, if one is used by the property

Any applicants with disabilities wishing to request a reasonable accommodation to complete the application process may contact the Community Manager by phone or letter. Las personas con discapacidad, o que hablan espaflol y que requieren de un interprete , que deseen solicitar un alojamiento razonable para completar el proceso de solicitud deberan comunicarse con el administrador de la comunidad. Hearing impared individuals may call 711 to be connected to services to assist in contacting the property.

Maximum Occupancy:

Application Fees and Deposits:

Apartment Size: Effieciency One Bedroom Two Bedroom Three Bedroom

Maximum # of Occupants: 2 occupants 2 occupants 4 occupants 6 occupants

Rent Limits: 60% - $702.00 60% - $752.00 60% - $903 .00 60% - $1,042.00

Application fees are $20.50 for the P1 applicant and $15.00 per additional applicant. Deposits are $150.00 (Eff (0-bdrm)), $200 (1-bdrm), $250 (2-bdrm), $350 (3-bdrm) per apartment. This amount can increase to one month's rent depending upon credit scoring and are fully refundable based on lease contract guidelines.

Eligibility Requirements: In order to be accepted as a resident, each applicant must provide third party verification for required information in each of the categories listed below. Failure to meet eligibility requirements in any one or more of these categories will result in rejection of the application.

• Household Composition Definition of household composition: As listed on the application, the first or primary applicant. If only one person is applying, that person will be the head of household. Definition of co-head: the second applicant listed on the application.

• Income: Section 8 applicants are welcome. For affordable housing units, the household income must be within the maximum allowed income range as specified by TDHCA as applicable. The following is the maximum allowable income per household, by number of occupants.

Household Size: 60% Income Limits

1 Person $28,080

2 Person $32,100

Income/Employment History/ Asset Verifications:

3 Person $36,120

4 Person $40,080

5 Person $43,320

6 Person $46,500

7 Person $49,740

8 Person $52,920

All applicants must provide us with proof of income and assets prior to application approval. If any source of income or assets cannot be substantially documented we will obtain third party verifications. Acceptable forms of verification include but are not limited to:

• Four consecutive paycheck stubs for each applicant • Job offer with salary (on company letter head with contact information) • Most recent tax return or W-2 • Consecutive or most recent six months of bank statements • Child support or alimony when directed by a court • Grants, pensions, trust funds • GI benefits, disability, social security

Social Security Requirement: Applicants must disclose social security numbers (SSNs) for all family members if applicable. Foreign nationals/non.us citizens may be required to complete a supplemental rental application for non us citizens and provide va]id and current USCIS documentation and photo ID (passport, driver license, US identification card, or identification card from home country).

United Apartment Group Rental Criteria 5.12.2018

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Student Status:

• UNITED APARTMENT ---GRQUp---

Full time student households that are income eligible must satisfy and provide documentation for one or more of the following conditions to be considered an eligible resident:

• The adult member of the household are married or is entitled to file joint tax return • The household consists of a single parent(s) and their child(ren), and both the parents and the children are not dependent of another

individual • At least one member of the household received assistance until Title IV of the Social Security Act {i.e., AFDC, T ANF assistance) and/or • At least one member of the household is enrolled in a job training program and receiving assistance under the Workforce Investment Act,

or similar federal, state, or local programs or • Have been previously in the foster care system

Applicant Screening: Applicant screening is targeted toward determining that an applicant will be able to meet the essential requirements of tenancy as expressed in the lease and the community policies. Note: live-in aides are subject to the same criminal criteria as the applicant.

Identity Verification: Valid government~issued photo identification must be presented by all applicants and guarantors over the age of 18. Our privacy policy is available to you upon request.

Credit History/Criminal History: All applicants must have established retail credit in good standing. Lack of established credit or negative credit may require an additional deposit, or other conditions. Items reviewed to determine eligibility are FICO score, check writing history, evictions, judgments and bankruptcies. Negative credit includes but is not limited to the following:

• Past due accounts • Judgements • Liens • Write offs • Balance to a rental community or mortgage company (regardless of date) • Unresolved bankruptcy (regardless of date)

A criminal background check will be conducted for each applicant 18 years of age and over. It is our policy to review applicants who pass all other rental criteria. Applicants with felony convictions or serious misdemeanor convictions for crimes against persons or property, drugs, assaults, weapons or crimes of a sexual nature may result in a denial of your application. The review process may require the applicant to complete additional paperwork for further review of the crime itself. We have a screening process that bases its conditional approvals upon the type of criminal conduct, age of conviction and history after conviction.

Credit and Criminal screenings are conducted by RealPage, a score of less than 400 will result in a denied application. Additional reviews and approvals may be required depending on the conditional results of the screening process. Additional reviews will be conducted by the community supervisor and may be overridden for due to individual circumstances, histories, or the lack of social security numbers.

Rental/Mortgage History: All applicants 18 years of age and over who are mentally competent are required to sign the lease agreement for no less than one (1) year and must have satisfactory verifiable rental history. All applicants must have six months verifiable, satisfactory rental or mortgage payment history. If an applicant does not have prior rental history, we will accept a deposit equal to one month's rent if all other criteria has been met. An eviction or foreclosure could constitute cause for denial and forfeiture of all fees paid. Less than six months of history or first time renters may be required to, pay an additional deposit, or other conditions.

• Lease term fulfilled • No lease violations • Residence left in satisfactory condition • Proper notice to vacate given

Pet Policy: In accordance with our Lease, we authorize support animals for a disabled person. We will require a written statement from a qualified professional if the pet exceeds our criteria. Service animals will be allowed after third party verification has been received from the ordering physician. Specific animal, breed, number, weight restrictions, pet rules and pet deposits will not apply to households having a qualified service/assistance animal(s). Accommodations do not extend to any animal posing a direct threat to the health or safety of others. An additional deposit and fee will be required for animals accepted within the accepted weight limits. Non~acceptable canine breeds are: Pit Bulls, Rottweiler's, Dobermans, German Shepherds, Husky, Malamute, Akita, Wolf- Hybrid, St. Bernard, Great Danes, Chows, Bull Mastiff and Standard Poodles, unless proper documentation is provided in advance that the pet is a service animal and a reasonable accommodation has been requested. Only two pets per apartment are allowed. There is a $250.00 refundable pet deposit, two pets requires a $500.00 refundable pet deposit. A pet agreement on file is required.

Utilities: All residents will be responsible for their electricity. Water, sewer and trash will be paid by the owner. Proof of utility account numbers and transfer must be provided to management prior to lease signing. Utilities applicable as stipulated in the lease contract.

Waiting list and Apartment Transfers: Leasing is based on a first come, first serve basis. Applicant(s) and current residents will be placed on a waiting list in chronological orders by

preference of apartment home size and income designation. The waitlist status if closed will be posted in the management office. • Applicant will be required to complete a rental application, supplemental rental application and pay the necessary application fees. The

management will screen the household for criminal and credit. Depending on the date of move-in, these forms and fees may need to be completed again prior to move-in.

• Any applicant requiring an accessible unit will be a priority when one becomes available and will move to the top of the waitlist. • Once the unit size and income limit is determined, management will place the applicant on the appropriate waiting list. The waitlist will

order applicant by the date the application is received by management. When the applicants name reaches the top of the waitlist and a unit type becomes available, management will contact the applicant al the address, email address or phone number provided by the applicant.

• If we do not hear back from the applicant within 5 business days, management will attempt to contact the applicant a 2nd time. If we do not reach the applicant on the 2nd attempt and do not hear back from the applicant in 1 business day, we wiJl move to the next person on the waiting list. If the applicant turns down 3 apartments that meet their criteria provided, we reserve the right to remove the applicant from the waiting list.

• If the applicant is interested in the apartment that is available, the applicant will come to the office and complete the remaining part of the application paperwork within 2 business days. Management will screen the household for criminal and credit {if previous screening is older than 120 days) and verify income and assets. When the appointment is scheduled, the applicant will need to bring aU documentation requested by management.

United Apartment Group Rental Criteria 5.12.2018

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• UNITED APARTMENT ---GRour---

Household Units Transfers: For HTC, Exchange, and TCAP Projects: (1) 100 percent low-income multiple building projects: Households may transfer to any unit in a 100 percent low-income multiple building project and retain their program designation. The household does not need to be and should not be certified at the time of transfer. The move in date remains the date the household was first designated under the program. (2) Each building is its own project (100 percent low-income and mixed income projects). To retain its low-income status, at the time of transfer, a household must be certified and have a current annual income less than the income limit established by the minimum set aside the owner selected. (3) Mixed income multiple building projects: Low-income households retain their program designation when they transfer to any unit in the multiple building project if at the last annual certification their income was less than 140 percent of area median income level set by the minimum set aside.

Resident's interested in transferring to another unit may do so in the same building and retain their program designation. The household does not need to be and should not be certified at the time of transfer. The move in date remains the date the household was first designated under the program.

For Bond, HTF, HOME, and NSP Developments, households may transfer to any Unit within the Development: A certification is not required at the time of transfer. If the Development is required to perform annual income recertifications, the recertification is due on the anniversary date the household originally moved onto the Development. For HOME Developments, an income certificarion is required every sixth (6th) year anniversary of the HOME contract. If the Development is layered with Housing Tax Credits, you are required to use the transfer guidelines described in subsection (a) of this section (relating to Household Unit Transfer Requirements).

Household Transfers in the Same Building for all Programs: A Household may transfer to a new Unit within the same building (for the HTC program within the meaning of IRS Notice 88-91 ). The unit designations will swap status.

In order for a resident to transfer to another apartment within the community the resident must meet one of the following criteria: • Have experienced a change in household composition • Have experienced a change in income which is permanent in nature • Require a reasonable accommodation for a disability • Requests due to initiating a VA WA guide1ines

In addition, all transfers must meet the following guidelines: • Must fulfi11 at least one lease term (of one full year) in their current apartment (not applicable to reasonable accommodation for a disability

or VAWA guidelines) • Paid a $200 non-refundable transfer fee (not applicable to reasonable accommodation for a disability or VAWA guidelines)

If a resident meets one of these criteria, which must be verified and is qualified for the new apartment, and pays a non-refundable $200 transfer fee, they will be placed on the waiting list in the order the request for transfer is requested. Residents on the waiting list will not have priority over applicants on the waiting Hst. If a household on the transfer list refuses an appropriate unit when it becomes available, they will be moved to the bottom of the transfer list. The only exception to the waiting list order is the transfer due to the need for and accessible unit or V AWA accommodations. Note: All transfers must be approved by management. Transfers solely for the convenience of a resident are not authorized until the end of their lease tenn. All outstanding charges must be paid in full prior to transfer. Transfers will be based on previous rental history, payment history and lease violations. Three late payments and/or three lease violations can prevent a resident transfer from being approved.

Implementation of the Violence Against Women Act

The primary objectives of of the Violence Against Women Act (V AW A) are to reduce violence against women and to protect, or increase the protection of, the safety and confidentiality of women who are victims of abuse. VAWA provides legal protections to victims of domestic violence, dating violence, or stalking. These protections prohibit Owner/Agents from rejecting applicants, evicting or terminating assistance from individuals being assisted under a tax credit (LIHTC) program if the asserted grounds for such action is an instance of domestic violence or stalking.

The following documents must be provided to each applicant at the time they are notified of the acceptance or rejection of their application, and to each existing tenant through December 16, 2017:

1 . Form HUD-5382, Certification of Domestic Violence, Datinng Violence, Sexual Assault, or Stalking and Alternative Documentation 2. Form HUD-5380, Notice of Occupancy Rights under the Violence Against Women Act

Reasonable Accommodations: If a current resident or applicant is requesting a reasonable accommodation to their unit or direct path access, the request should be submitted in writing to the management office for review. Other methods will be accepted such as verbal in person requests, email requests or phone requests as a reasonable accommodation if requested by the applicant/resident, at which time you will be notified within lO days of the decision. If denied you can request further review by upper management. A decision will be made and the tenant/applicant will be notified within 10 days of that decision.

The Property will seek to identify and eliminate situations or procedures which create a barrier to equal housing opportunity for all. In accordance with Section 504, the Property will make reasonable accommodations for individuals with handicaps or disabilities (applicants or residents). Such accommodations may include changes in the method of administering policies, procedures, or services.

In reaching a reasonable accommodation with, or performing structural modification for otherwise qualified individuals with disabilities the Property is not required to:

a. make structural alterations that require the removal or altering of a load-bearing structure, b. provide support services that are not already part of its housing programs, C. take any action that would result in a fundamental alteration in the nature of the program or service,or d. take any action that would result in an undue financial and administrative burden on the Property, including structural

impracticality as defined in the Uniform Federal Accessibility Standards (UFAS).

Rejection Procedure: A letter is sent to the applicant, informing him/her of the rejection and the reason(s) for the rejection within 7 days of determination. The applicant is advised in this letter that he/she has 7 days of the date of the letter to request a review of rejection and the applicant may request a meeting with management of the community to appeal the rejection. The community supervisor will review the application and the decision to reject the applicant. To the extent practicable, this review will be completed within 5 business days of the applicants request for review. The applicant will be sent a written, final determination within five business days of completion of the review. Non-Renewal/Termination notices wi1l be given only for '"just cause". If notice is given it will state the nature of the violation(s) and reason for the determination to terminate/non-renew the lease. If you request an appeal or reasonable accommodation based upon this notice you will need to discuss it with the property manager. If necessary they will have 10 days to reply, 1f necessary it may have to be brought to the attention of upper management which could delay the decision up to an additional 10 days.

United Apartment Group Rental Criteria 5.12.2018

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Electronic Payments:

• UNITED APARTMENT ---GROur---

United Apartment Group encourages our residents to create an online account through our resident portal available on our community website www.hilltopoaksapts.com. This will conveniently allow you to pay your rent and manage your account online.

Equal Housing Opportunity: We do business in accordance with the Federal Fair Housing Laws (Title VIII of the Civil Rights Act of 1968, as amended by Fair Housing Community Development Act of 1974). It is illegal to discriminate against any person because of race, color, religion, sex, national origin, handicap or familial status.

"I hereby authorize United Apartment Group to obtain a consumer report, and any other information it deems necessary for the purpose of evaluating my application. I understand that such information may include, but is not limited to, credit history, civil and criminal information, records of arrests, rental history, employment/salary details, vehicle records, licensing records, and/or any other necessary information. I hereby expressly release United Apartment Group, and any procurer or furnisher of such information, and understand that my application information may be provided to various local, state and/or federal government agencies, including without limitation, various law enforcement agencies. I authorize United Apartment Group to bill my account for all fees associated with processing my application. By signing this document you acknowledge that you have had the opportunity to review the Rental Criteria. If you do not meet the rental criteria or have submitted incomplete or falsified application may lead to rejection of your application or immediate termination of your lease and any fees associated with processing the application will be forfeited as liquidated damages. This community will operate under an affirmative marketing plan. All Fair Housing Laws will be followed." I/We have read and understand the above rental criteria and authorize verification of the application information. I/We agree to all terms above.

I/We have read and understand the rental criteria for this community.

Date ----------------

Date ----------------

Date ----------------

Date ----------------

Date ----------------

Date ----------------Owner's Representative Signature

United Apartment Group Rental Criteria 5.12.2018

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TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS RELEASE AND CONSENT FORM

I. THIS SECTION TO BE COMPLETED BY ADMINISTRATOR/OWNER/MANAGEMENT

Administrator/Owner/Management Name: TDHCA Number:

Contact Name: Contact Title:

Address: Phone:

Email Address: Fax:

II. THIS SECTION TO BE COMPLETED BYAPPLICANT

Applicant/Resident Name:

I/We------------------------~ the undersigned hereby authorize all persons or companies in the categories listed below to release information regarding employment, income and/or assets for purposes of verifying information on my/our application for participation in a Texas Department of Housing and Community Affair's (TDHCA) Affordable Housing Program. I/we authorize release of information without liability to the administrator/owner/management listed above, and/or the Texas Department of Housing and Community Affairs and/or the Department's service provider.

INFORMATION COVERED

I/We understand that previous or current information regarding me/us may be needed. Verifications and inquires that may be requested include, but are not limited to: personal identity, student status, employment, income, assets, and medical or child care allowances. I/We understand that this authorization cannot be used to obtain information about me/us that is not pertinent to my eligibility for and continued participation in a TDHCA Affordable Housing Program.

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 Welfare Agencies

Support and Alimony Providers State Unemployment Agencies

Educational Institutions Social Security Administration

Bank and other Financial Institutions Utility Providers

Public Housing Agencies Appraisal Districts

III. APPLICANT CERTIFICATION

Veterans Administrations

Retirement Systems

Medical and Child Care Providers

Previous Landlords

Insurance Carrier

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 a year and one month from the date signed. I/We understand I/We have a right to review this file and correct any information that is incorrect.

Applicant/Resident Printed Name Signature Date

Co-Applicant/Resident Printed Name Signature Date

Adult Member Printed Name Signature Date

Adult Member Printed Name Signature Date

NOTE: THIS GENERAL CONSENT MAY NOT BE USED TO REQUEST A COPY OF AT AX RETURN. IF A COPY OF AT AX RETURN IS NEEDED, IRS FORM 4506, .. REQUEST FOR COPY OF AT AX FORM" MUST BE PREPARED AND SIGNED SEPARATELY.

TDHCA Page I of I Revised May 2010

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TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS EMPLOYMENT VERIFICATION

.· I. TfflSSECTION IS TO.BE,COMPLETED BY ADMINISTRATOR/OWNER/MGMT & EXECUTED BY APPLICANT/RESIDENT

TO: (Name of Employer) Dated:

Employer Address: Phone/Fax:

RE: (Applicant/Resident Name) Social Security Number:

RELEASE: My signature here or on the attached "'Release and Consent Form" authorizes the release and/or verification of my employment information.

.,

Applicant/Resident Printed Name Signature Date

"I'he .indiyidu,il(paryied directly aboye is ail applicanVresident of a. Texas Department of Housing. and Community A ff airs Affordable ln(()rma~on Jilqqsin.g ffOgraJtl which requires verification of income; We ask your cooperation in supplying this infonnation to the below

rc;f~rencp<I ~~11istrator/Owner/Management .. The infonnation p1uvided will·.· remain confidential and. used. only. to. determine the ~Iigibilify status andlevelofbenefit availableto the applicant/resident. Please return this completed fonn by mail or fax to:

Administrator/Owner/Management Name:

Address:

Email Address:

Your prompt response is crucial and greatly appreciated,

Administrator/Owner/Mgmt Authorized Rep. Printed Nameffitle

Signature

TDHCA Number:

Phone:

Fax:

Date

11.THISSECTIONTO BE COMPLETEDBYEMPLOYER

Employee Name: Job Tille:

Presently Employed: • YES • NO Date First Employed: Last Day of Employment: or D Not Applicable

Current Wages/Salary: $ (circle one) hourly/ weekly/ bi-weekly/ semi-monthly/ monthly I yearly/ other:

Average# of regular hours per week: Year-to-date earnings: $ through

Overtime Rate: $ per hour Average # of ove11ime hours per week:

Shift Differential Rate: $ per hour Average # of shift differential hours per week:

Commissions, bonuses, tips, other: $ (circle one) hourly I weekly/ bi-weekly I semi-monthly/ monthly/ yearly/ other: ___

List any anticipated change in the employee's rate of pay within the next 12 months: Effective date:

lf the employee's work is seasonal or sporadic, please indicate the layoff period(s):

Do Employees have access to an Employer Retirement Account prior to termination or retirement? • YES • NO

Additional remark(s):

lll~EMPLOYER AUTHORIZED REPRESENTATIVE CERTIFICATION I certify that the above infonnation is true and correct,

Signature of Employers Authorized Representative Representative's Title Date

Authorized Representadve's Printed Name Phone# Fu# Email

Employer JCompanyl Name and Address

Note: Title 18, Section JOOt of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction.

TDHCA Page I of l Revised May 2010

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Child Support/ Alimony Certification

Applicant/ Resident: ______________ _ Apt#: ________ _

Child (rcn's) Name(s): ______________________________ _

Please check only one box (and complete any blanks) that explains your entitlement lo child support or alimony.

} I am not entitled to receive any alimony, spousal suppon, child support or other compensation pursuant to any court order or other agreement.

I am not in the process of seeking any monies for alimony, spousal support or child support through legal channels or otherwise. I am not under any affirmative obligation to seek such monies.

] I am entitled to receive alimony. spousal support, child support or other compensation pursuant to a court order or other agreement in the amount of$ ______ per month. I will provide supporting documentation such as Divorce Decree or Court Order that may be required.

Notwithstanding the above, l expect to receive no more than $ ______ over the next twelve months. I do not expect to receive the full amount of money due to me because:

I have taken the following legal actions in attempt to collect the monies owed to me (I will provide supporting) Documentation that may be required):

J Although I am nm currently entitled to receive any alimony, spousal support, child suppon or other compensation pursuant to a court order or other agreement, I believe I will receive$ ______ per month commencing on

, 20 __ because:

I/We understand that this verification is made as part of the qualification procedure to determine eligibility for residency al the above apanment community and that any misrepresentation herein will be considered material breach of the lease agreement and subject me/us to immediate eviction. Under penalties of perjury, 1/We certify the above representations to be true as nf the date shown below.

Applicant Signature: ______________ _

Co-Applicant Signature _______________ _

Date: ________ _

Date: __________ _

TC# 109

03/04

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TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS UNDER $5,000 ASSET CERTIFICATION

For households whose combined net assets do not exceed $5,000. Complete only one form per household; include assets of children.

Household Name: __________________________ Unit No. ___________ _

Development Name: ___________________________ City: ___________ _

Complete all that apply for 1 through 4:

1. My/our assets include:

(A) (B) (A*B) (A) (B) (A*B) Cash Int. Annual Cash Int. Annual

Value* Rate Income Source Value* Rate Income Source $ $ Savings Account $ $ Checking Account

$ $ Cash on Hand $ $ Safety Deposit Box

$ $ Certificates of Deposit $ $ Money market funds

$ $ Stocks $ $ Bonds

$ $ IRA Accounts $ $ 401K Accounts

$ $ Keogh Accounts $ $ Trust Funds

$ $ Equity in real estate $ $ Land Contracts

$ $ Lump Sum Receipts $ $ Capital investments

$ $ -'------ Life Insurance Policies (excluding Term)

$ $ Other Retirement/Pension Funds not named above: -----$ $ -'------ Personal property held as an investment**:

$ $ -'----- Other (list):

PLEASE NOTE: Certain funds (e.g., Retirement, Pension, Trust) may or may not be (fully) accessible to you. Include only those amounts which~-

*Cash value is defined as market value minus the cost of converting the asset to cash, such as broker's fees, settlement costs, outstanding loans, early withdrawal penalties, etc.

**Personal property held as an investment may include, but is not limited to, gem or coin collections, art, antique cars, etc. Do not include necessary personal property such as, but not necessarily limited to, household furniture, daily-use autos, clothing, assets of an active business, or special equipment for use by the disabled.

2. •

3. •

4. •

Within the past two (2) years, I/we have sold or given away assets (including cash, real estate, etc.) for more than $1,000 below their fair market value (FMV). Those amounts* are included above and are equal to a total of: $ __________ (*the difference between FMV and the amount received, for each asset on which this occurred).

I/we have not sold or given away assets (including cash, real estate, etc.) for less than fair market value during the past two (2) years.

I/we do not have any assets at this time.

The net family assets (as defined in 24 CFR 813.102) above do not exceed $5,000 and the annual income from the net family assets is $ ______ . This amount is included in total gross annual income.

Under penalty of perjury, I/we certify that the information presented in this certification is true and accurate to the best of my/our knowledge. The undersigned further understand(s) that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of a lease agreement.

Under $5,000 Asset Certification (September 2000)

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CERTIFICATION OF STUDENT ELIGIBILITY

Household Name:

Check A, B or C as applicable (note that students include 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.

B.

C.

1.

2.

3.

4.

5.

Household contains at least one occupant who is not a student, has not been a student, and will not be during the current and/or upcoming calendar year. A student is defined as someone who attends school full time for any part of five or more months in a calendar year (months need not be consecutive). If this item is checked, no further information is needed. Household contains all students, but is qualified because the following occupant(s)

is/are part-time student(s). Documentation of part-time student status for at least one member of the household. Household contains all full-time students for five or more months during the current and/or upcoming calendar year (months need not be consecutive). If this item is checked, questions 1-5, below must be completed.

Is at least one student receiving assistance under title IV of the Social Security Act (for Yes No example, payments under AFDC)? Was at least one student previously under the care and placement responsibility of the Yes No state agency responsible for administering foster care? (provide documentation of participation) Does at least one student participate in a program receiving assistance under the Job Yes No Training Partnership Act (JTPA), Workforce Investment Act or under other similar federal, state or local laws? (attach documentation of participation) Is at least one student a single parent with child(ren) and this parent is not a dependent Yes No of another individual and the child(ren) is/are not dependent(s) of someone other than a parent? Are the students married and entitled to file a joint tax return? Yes No

Households composed entirely of full-time students that are income eligible and satisfy one or more of the above conditions are considered eligible. If questions 1-5 are marked NO, or verification does not support the exception indicated, the household is considered an ineligible student household.

I/we hereby certify that the statement above is true and complete to the best of my knowledge.

Applicant/Resident Signature Da:e·-- Applicant/Resident Signature Date

Printed Name

WARNING:

Printed Name

Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to willfully falsify a material fact or make a false statement in any matter within the jurisdiction of a federal agency.

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