HALE MAHAOLU HOUSING APPLICATION

Transcription

1 HALE MAHAOLU HOUSING APPLICATION General Infrmatin: Hale Mahalu is a private, nnprfit husing crpratin that develps, wns and manages lw- and mderate-incme husing units thrughut Maui Cunty fr families, senirs, and/r thse with disabilities. Husing applicatins may be drpped ff at any Hale Mahalu lcatin (Mnday thru Friday, 8:00 a.m. t 12:00 p.m.) r mailed in t 200 Hina Avenue, Kahului, Hawaii Print clearly in ink. Cmplete all infrmatin as required. Incmplete applicatins will nt be accepted. Signatures required by all adults (head / c-head f husehld). must be a U.S. Citizen r natinal r nncitizen with eligible immigratin status. Check all f the Husing Preferences yu want t apply with. Hale Mahalu will nt chse n yur behalf. Sme husing sites are fr senirs nly; ther sites are listed as fr family fr singles and families with head f husehld ver the age f 18. There are incme limits at mst sites. The husehld grss incme must be less than r equal t the established HUD maximum incme limit fr the husehld size. Cntact the Husing Site fr specific infrmatin. Cmpleted applicatins are prcessed in the rder they are received, n a first cme, first served basis. Each Husing Site maintains and manages its wn wait list. An applicant may nly have ne (1) active applicatin n each individual husing site wait list. After receiving the applicatin, each husing site checked n the Husing Preference will respnd t applicant in writing with its preliminary determinatin f eligibility. If the applicatin is accepted, yur name will be placed n a waitlist n a first-cme-first served basis fr upcming vacancies. Prir t placement, yu will be ntified in writing and additinal infrmatin and frms (verificatin f current incme, assets, etc.) will be required. All Hale Mahalu husing sites have a N Smking Plicy and Drug Free Plicy. Federally funded / subsidized husing prhibits the use f cntrlled substances including medical marijuana. Hale Mahalu prvides equal husing pprtunity; we d nt discriminate n the basis f race, clr, religin, sex, disability, natinal rigin and familial status. Applicatin will be denied r remved frm the waitlist fr the fllwing reasns: Any husehld member has been evicted frm Federally-assisted husing fr drug-related criminal activity, fr three years frm the date f evictin. If the evicted husehld member wh engaged in drug-related criminal activity has successfully cmpleted a supervised drug rehabilitatin prgram r circumstances leading t the evictin n lnger exist, the Owner may, but is nt required t, admit the husehld. Any husehld member has engaged in illegal drug use. The Owner/Managing Agent determines that there is reasnable cause t believe that a husehld member s illegal use r a pattern f illegal use f drugs may interfere with the health, safety, r right f peaceful enjyment f the premises by ther residents. (Examples f evidence f illegal activities may include a cnvictin recrd, frmer landlrd references, etc.) Federally funded / subsidized husing prhibits the use f cntrlled substances including medical marijuana. Any member f the husehld is subject t a lifetime registratin requirement under a state sex ffender registratin prgram. In accrdance with Federal law, Owner/Managing Agent shall establish standards that prhibit admissin t any Federally-assisted prperty t sex ffenders subject t a lifetime registratin requirement under a state sex ffender s registratin prgram. Applicatin Instructins Octber 2018

2 The Owner/Managing Agent determines that there is reasnable cause t believe that a husehld member s abuse f alchl interferes with the health, safety, r right t peaceful enjyment f the premises by ther residents. Within 25 years befre the admissin decisin, yu had a cnvictin fr: Vilent criminal activity; Drug-related criminal activity; Other criminal activity that wuld threaten the health, safety, r right t peaceful enjyment f the premises by ther residents; r Other criminal activity that wuld threaten the health r safety f the Owner/Managing Agent, r any emplyee, cntractr, subcntractr, r agent f the Owner wh is invlved in the husing peratins. Negative landlrd reference. Falsifying f infrmatin n the applicatin. Unsatisfactry credit histry. Verbal and/r physical harassing, threatening and/r intimidating Hale Mahalu s persnnel and its vlunteers, cntractrs, vendrs, etc. Demnstrated aggressive and/r repeated behavir that may result in serius r repeated interference with the rights and quiet enjyment f ther tenants. Mve In Qualifying Criteria: A persnal (physical face t face) interview must be cnducted at the site prir t the ffer f a unit. s must sign and submit verificatin cnsent frms. During the admissin screening prcess, applicants must successfully pass criminal and credit histry backgrund checks in the state where the husing is lcated and ther states where the husehld members are knwn t have resided. must have acceptable rental histry frm landlrd(s) as listed n applicatin. Unit Assignment: Units are assigned by existing resident accmmdatin requests, VAWA regulatin and wait list status. When a unit is ffered, yu are allwed ne first refusal per husing site that yu are waitlisted. Yu will remain n the respective wait list and maintain yur status. A secnd refusal will result in yur applicatin being cancelled frm that particular site. Yu will be ntified f a unit when yur name cmes up n the waitlist. Ntificatin may be less than 30 days. Applicatin Instructins Octber 2018

3 HALE MAHAOLU APPLICATION FOR RENTAL HOUSING Please Print Clearly Name (First, MI, Last): Mailing Address: City State, Zip: Alternate Cntact Persn: Alternate Cntact Phne Number: Alternate Cntact Infrmatin Primary Phne: Other Phne: Relatinship: Husehld C Husehld Relatinship t self A. Family Cmpsitin Husehld (s) Applying fr Husing First Name Last Name **Fr additinal family members attach a separate sheet, if necessary** Place f Birth: City, State, Cuntry Date f Birth (MM/DD/YYYY) Occupatin xxx-xxxxx-xx- 3 xxx-xx- 4 xxx-xx- 5 xxx-xx- 6 xxx-xx- C- Husehld B. Incme & Family Assets (Attach a separate sheet, if necessary) Student? (Y/N) Scial Security number r Alien Registratin number Current Emplyment: Identify each wrking member by Husehld frm Family Cmpsitin in Sectin A. Emplyer s Name GROSS pay per hur r mnth Wrk hurs per week Estimated Annual GROSS Pay This Year Next Year Current Self Emplyment/Business Incme (Include Rental Incme): Identify each wrking member by Husehld frm Family Cmpsitin in Sectin A. Husehld Business Name NET incme per mnth Estimated Annual NET incme This Year Next Year P a g e 1 f 4 Husing App-Rent up.dc (040419)

4 Other Incme: Identify each incme by Husehld frm Family Cmpsitin in Sectin A. Husehld Surce Grss Mnthly Amunt Husehld Surce Grss Mnthly Amunt Scial Security: Veteran s Pensin: Supplemental Security (SSI): Veteran s Educatinal Benefits: Unemplyment Cmpensatin: Legally Entitled Child Supprt frm: Wrkers Cmpensatin: Other Child supprt frm: Retirement frm: Legally Entitled Alimny: Pensin frm: Supprt frm Adult Children: Scheduled Payments frm Investments r Annuities: Financial Aid (excluding lans): Welfare Assistance Type: Other: Husehld Husehld Assets: Identify each asset by Husehld frm Family Cmpsitin in Sectin A. (Attach a separate sheet, if necessary) Checking / Savings / CD s / IRA s / Direct Express List names f Institutin, Bank, Credit Unin, etc. Ttal Value Amunt List all real prperty: Lcatin Est. Market Value Est. Equity Husehld Husehld Stcks/Mutual Funds List Names List all Bnds: Denminatin # f shares # f bnds Ttal Estimated Value Ttal Estimated Value Husehld List all Trust Accunts: Lcatin Est. Market Value Est. Equity Husehld List all Life Insurance Accunts: Whle/ Term Ttal Face Value P a g e 2 f 4 Husing App-Rent up.dc (040419)

5 C. Additinal Infrmatin & Criminal Histry Yes N Yes N Yes N Yes N Yes N 1. D yu require t have a mbility-impaired unit? (If yes, Mbility Impaired frms must be cmpleted and turned in with applicatin) 2. Des husehld currently ccupy a HUD-assisted unit? 3. Have yu r any member f yur husehld been evicted frm any husing? 4. Are yu r any member f yur husehld currently using illegal substances? Federally Funded/Subsidized Husing Prhibits the Use f Cntrlled Substances including Medical Marijuana 5. Are any members f the husehld subject t lifetime sex ffender registratin in any state? Yes N 6. Have yu r any ther persn n yur applicatin been cnvicted f any ffense against the law within the past 25 years? (If YES, list each ffense and the date. Attach a separate sheet, if necessary. Omit traffic vilatins and any ffense tried in juvenile curt): 10. List all states where all members f the husehld have resided (attach a separate sheet, if necessary): D. Rental Histry Present Landlrd: Hw Lng? Hme Phne: Landlrd Mailing Address: Wrk Phne: Reasn fr leaving: Previus Landlrd: Hw Lng? Hme Phne: Landlrd Mailing Address: Wrk Phne: Reasn fr leaving: Previus Landlrd: Hw Lng? Hme Phne: Landlrd Mailing Address: Wrk Phne: Reasn fr leaving: P a g e 3 f 4 Husing App-Rent up.dc (040419)

6 E. Husing Preferences CHECK all the husing site(s) where yu wish t live. Hale Mahalu will nt check r chse f yur behalf. Applicatin will be rejected if n husing site(s) is selected. If yu are ffered a unit at a husing site f yur chice and yu dn t accept it, this will be cunted as a refusal at that site. After tw (2) refusals, yur applicatin will be taken ff that respective husing site s waiting list. Only ne active applicatin per husehld per site allwed. SENIORS: (age 62+ unless therwise nted) INDIVIDUALS / FAMILIES: (Head f Husehld age 18+) AKAHI, Kahului ( ) (N Subsidy) LAHAINA SURF, Lahaina ( ) (N Mbility Impaired Units) ELUA, Kahului ( ) KOMOHANA HALE, Lahaina ( ) (N Subsidy) ELIMA, Kahului ( ) LUANA GARDENS, Kahului ( ) EKOLU, Wailuku ( ) KULAMALU HALE, Pukalani ( ) (N Subsidy) EHIKU, Kihei ( ) Nte: Husing Sites listed abve have a N Pet Plicy EHA, Makawa ( ) EONO, Lahaina ( ) LOKENANI HALE (age 55+), Wailuku ( ) (N Subsidy) HOME PUMEHANA, Kaunakakai, Mlkai ( ) HALE KUPUNA O LANAI, Lanai City, Lanai ( ) NOTE: Hale Mahalu Ewalu Phase I senir husing prperty is nt included in this applicatin. ** ALL HALE MAHAOLU SITES HAVE A NO SMOKING POLICY & DRUG FREE HOUSING POLICY ** Federally Funded/Subsidized Husing Prhibits the Use f Cntrlled Substances including Medical Marijuana F. Certificatin I certify that the abve infrmatin is crrect t the best f my knwledge; that the unit being applied fr will be my (ur) permanent residence and agree nt t maintain a separate subsidized rental unit; that I am nt falsifying r withhlding any infrmatin frm HALE MAHAOLU, and I understand that false statements r infrmatin may be punishable under Federal Law. IF HALE MAHAOLU IS UNABLE TO CONTACT ME (US) AT THE ADDRESS PROVIDED, MY (OUR) APPLICATION WILL BE CANCELLED. I als understand that HALE MAHAOLU assumes NO respnsibility fr applicatins NOT received. I authrize HALE MAHAOLU t btain and verify infrmatin abut the incme, assets, persnal data, and cnduct f all persns listed in my family. I als authrize the surces f such infrmatin (which may include, but nt be limited t emplyers, scial wrkers, landlrds, resident mangers, husing managers, welfare wrkers, parle fficers, curt recrds, drug treatment centers, clinics, physicians, r the plice department) t release such requested infrmatin. I authrize Hale Mahalu t phne me cllect if necessary. Signature () Date Signature (C-applicant) Date Optinal Infrmatin The infrmatin regarding race, natinal rigin, and sex designatin slicited n this applicatin is requested in rder t assure the Federal Gvernment, acting thrugh the Rural Develpment, that federal laws prhibiting discriminatin are cmplied with. Yu are nt required t furnish this infrmatin, but are encuraged t d s. This infrmatin will nt be used in evaluating yur applicatin nr t discriminate against yu in any way. Hwever, if yu chse nt t furnish it, the wner may be required t nte the race/natinal rigin and sex f individual applicants n the basis f bservatin r surname. Marital Status Race / Natinal Origin Married White Black / African American Male Separated Asian Native Hawaiian / Pacific Islander Unmarried American Indian / Alaskan Native Female Single Widwed Hispanic / Latin Nt Hispanic / Latin Divrced T be cmpleted by HALE MAHAOLU Received by: Date: Time: Sex Cnfirmatin f Acceptance/Rejectin sent by: Date: MAIL TO: HALE MAHAOLU 200 HINA AVENUE, KAHULUI, MAUI, HAWAII *P:(808) *TDD ext.432 P a g e 4 f 4 Husing App-Rent up.dc (040419)