Western Management 1654 The Alameda Suite 100 San Jose, California

Size: px
Start display at page:

Download "Western Management 1654 The Alameda Suite 100 San Jose, California"

Transcription

1 Fax COMMUNITY NAME PROPERTY MANAGER FROM FAX PAGES PHONE DATE REGARDING Rental Applicatin CC Urgent Fr Review Please Cmment Please Reply Please Recycle Cmments: Western Management 1654 The Alameda Suite 100 San Jse, Califrnia

2 RENTAL APPLICATION TERMS AND AUTHORIZATION WESTERN MANAGEMENT, LLC. Thank yu fr yur interest in Western Management prperties and allwing us the pprtunity t prvide rental and sales services t yu. T ensure the prcess ges smthly fr all parties, the fllwing guidelines are in effect fr all applicatins. Applicatin Submissin 1. Applicatin must be cmpleted in its entirety and signed by each adult (18 years and lder) planning t ccupy the prperty. 2. If applicant des nt qualify n wn, a guarantr must be secured. The guarantr must als submit a cmpleted applicatin and the guarantr frm (which must be ntarized), as well as pay the applicatin fee. 3. A $25.00 nn-refundable applicatin/credit check fee fr each adult applicant must be paid in full at the time f applicatin submissin. We nly accept mney rder, cashier s check, persnal check, and sme cmmunities als accept credit card payments (MasterCard, Visa, and Discver). We d nt accept cash. 4. A cmpleted applicatin cnsists f ALL f the fllwing: Applicatin Terms and Cnditins Acknwledgement Credit Check Request and Authrizatin Frms Valid Identificatin (example: driver's license, r gvernment issued ID) Scial Security Card r Identificatin (example: ther identificatin number) Mst Recent Pay-Stub r Prf f Incme (If yu are self-emplyed, we will need yur mst recent tax returns t verify incme.) Applicatin Prcessing 5. Upn receipt f cmpleted applicatin and applicable fees, yur applicatin will be sent t prcessing, which will cnsist f the fllwing: Prcess yur applicatin Review yur credit reprt Review yur backgrund check Verify yur emplyment/incme Verify yur current and/r past landlrd reference 6. On average, applicatins and supprting infrmatin are reviewed by the cmmunity manager fr apprval within 48 hurs, prvided all the infrmatin is crrect and can be verified. In the event that yur infrmatin cannt be verified as submitted, yu may be asked t prvide additinal infrmatin t cmplete the prcessing. 7. There are tw ways t submit an applicatin: Optin 1: Cmplete the Online Rental Applicatin and pay nline. The nline rental applicatin can be fund at Optin 2: Cmplete the Printable Rental Applicatin and pay by ne f the fllwing methds. The printable rental applicatin can be fund at Hand deliver the applicatin t the cmmunity yu are applying fr and pay the applicatin fee upn delivery. Fax it t the prperty and pay the applicatin fee t the prperty manager. Scan and it t the cmmunity yu are applying fr and pay the applicatin fee t the prperty manager. Arrange fr anther methd f delivery and pay fr the applicatin fee t the prperty manager directly. Applicatin Apprval 8. Upn receipt f all required verificatins and references, applicatins will be sent t management fr apprval. After a decisin has been made n yur applicatin, we will d ne f the fllwing: Denial: We will cntact yu in writing. Acceptance: We will ntify yu and arrange fr lease preparatin and mving in. Yu will have tw business days t sign the lease and pay the security depsit t secure yur rental unit. Please nte that the prperty will remain n the market until the lease is signed and a security depsit is paid. 9. Once the applicatin has been accepted, yu will be required t pay the fllwing fees prir t mving in: First mnth's rent Security depsit Additinal depsit fr pet Fr the fastest service, please apply n ur website, Thank yu fr yur interest in ur prperties and we lk frward t wrking with yu! Western Management supprts the spirit and intent f all lcal, state and federal fair husing laws fr all residents withut regard t clr, race, religin, sex, marital status, mental r physical disability, age, familial status, sexual rientatin, r natinal rigin.

3 Rental Applicatin I hereby submit an applicatin t rent the prperty lcated at: _beginning (mm/dd/yyyy), fr an initial term f fr $ per mnth, and submit the fllwing infrmatin: Persnal Infrmatin Legal Name f Applicant: Last First Middle Current Street Address: City State Zip Other names used in the last 10 years Wrk phne number Address Telephne: Mbile/Cell Hme Wrk Date f Birth (MM/DD/YYYY) Scial Security Number - - Mnthly Incme Pht ID/Type Number Issuing Gvernment Exp. Date Other ID Prpsed Occupants and Dependents (All Occupants 18 and Over MUST Fill Out An Applicatin) Name Date f Birth (MM/DD/YYYY) Relatinship Name Date f Birth (MM/DD/YYYY) Relatinship Name Date f Birth (MM/DD/YYYY) Relatinship Name Date f Birth (MM/DD/YYYY) Relatinship Rental Histry Current Street Address City State Zip Landlrd r Agent Telephne and Fax Current Rent $ Date In Date ut Reasn fr Leaving Previus Street Address City State Zip Landlrd r Agent Telephne and Fax Date In Date Out Reasn fr Leaving Previus Street Address City State Zip Landlrd r Agent Telephne and Fax Date In Date Out Reasn fr Leaving Emplyment Infrmatin Present Occupatin r surce f incme Emplyer Name Dates f Emplyment Current Grss Incme Week Mnth Year Supervisr Emplyer Address Telephne Fax Prir Occupatin Emplyer Name Dates f Emplyment Current Grss Incme Week Mnth Year Supervisr Emplyer Address Telephne Fax Western Management supprts the spirit and intent f all lcal, state and federal fair husing laws fr all residents withut regard t clr, race, religin, sex, marital status, mental r physical disability, age, familial status, sexual rientatin, r natinal rigin.

4 Other Infrmatin Autmbile Make Mdel Year License Plate State Driver s License Number and State Have Yu Ever Been Cnvicted f a Felny (select ne) N Yes, When: Have Yu Ever Filed fr Bankruptcy (select ne)? N Yes, When: Emergency Cntact Fr Hme r Recreatinal Vehicle Lt Rentals Only Have yu Ever Been Evicted (select ne)? N Yes, When: Hw Did Yu Hear Abut Us? Make/Mdel: Length: Width: Height: Year: Breaker Size: amps. License r Decal Number: Serial Number: Value: Financed By: Current Lcatin: Legal Owner Name/Address: Registered Owner Name/Address: Junir Lienhlder Name/Address (if any): Pets, If Applicable- Please Submit Clr Pht f Each Pet Type (dg, cat, etc.) Breed Weight Clr Type (dg, cat, etc.) Breed Weight Clr - VERY IMPORTANT- This will be ur primary methd f cmmunicatin regarding yur applicatin Western Management supprts the spirit and intent f all lcal, state and federal fair husing laws fr all residents withut regard t clr, race, religin, sex, marital status, mental r physical disability, age, familial status, sexual rientatin, r natinal rigin.

5 Western Management Rental Applicatin Terms and Cnditins Applicant represents that all the abve statements are true and crrect and hereby authrizes verificatin f the abve items including, but nt limited t, the btaining f a credit reprt and agrees t furnish additinal credit references upn request. Applicant cnsents t allw Owner/Agent t disclse tenancy infrmatin t previus r subsequent Owners/Agents. Applicant understands that payment f a Nn-Refundable Fee f $25.00 is required in rder t prcess an applicatin. The fee will be used t screen Applicant with respect t credit histry and ther backgrund infrmatin. The amunt charged is itemized as the actual cst f credit reprt, unlawful detainer (evictin) search, and/r ther screening reprts. The undersigned is applying t rent the premises designated as: Unit/Apartment Number: Lcated at The rent fr which is $ per. Upn apprval f this applicatin, and executin f a rental/lease agreement, the applicant shall pay all sums due, including required security depsit f $, befre ccupancy. Cpies f Applicant s valid scial security card, valid gvernment issued identificatin, and recent pay stub must be returned with the applicatin. NO UNITS WILL BE HELD UNTIL THE SECURITY DEPOSIT IS RECEIVED BY AGENT. IT IS RECOMMENDED THAT APPLICANTS DELIVER THE SECURITY DEPOSIT WITH THE APPLICATION IN ORDER TO GUARANTEE THE AVAILABILITY OF THE UNIT. APPROVALS MAY BE WITHDRAWN IF THE SECURITY DEPOSIT IS NOT RECEIVED WITHIN 2 DAYS FROM ACCEPTANCE. Applicant authrizes, as a part f Agent s prcedure fr prcessing this applicatin, preparatin f an investigative cnsumer reprt whereby infrmatin is btained thrugh persnal interviews with Applicant s references, as may r may nt be listed in this reprt. This inquiry may invlve requests fr infrmatin as t Applicant s character, general reputatin and persnal characteristics. Permissin is hereby granted by Applicant t any credit bureau t verify any infrmatin btained frm any surce named herein. Applicant hereby authrizes any present r frmer Landlrd t give any infrmatin he r she may have regarding Applicant in his r her capacity as Landlrd. Further, Applicant hereby releases such Landlrd r frmer Landlrd and his r her cmpany r representatives theref frm any and all liability fr any damage r injury whatsever caused fr issuing the same. The infrmatin cntained in my applicatin, t the best f my knwledge, is true and crrect. Applicant Date: Western Management supprts the spirit and intent f all lcal, state and federal fair husing laws fr all residents withut regard t clr, race, religin, sex, marital status, mental r physical disability, age, familial status, sexual rientatin, r natinal rigin.

6 Western Management Applicant Credit Check Request and Authrizatin I authrize Western Management, LLC. t btain my present and previus residence infrmatin, as well as any current and previus emplyment infrmatin. This includes any salary r ther pertinent infrmatin that may assist in cmpleting my rental applicatin. I further authrize Western Management, LLC. t verify my credit histry and perfrm a criminal recrd search by any means deemed reasnable. I understand that the infrmatin that Western Management btains is t be used nly in the prcessing f my rental applicatin. Further, I authrize my current and frmer emplyers as well as ther rganizatins t prvide such infrmatin. I hereby release and hld harmless Western Management, my current and frmer emplyers, my current and frmer landlrds, and any ther rganizatins wh have prvided infrmatin frm any and all liabilities arising ut f the use f such infrmatin in cnnectin with my cnsumer reprt. Applicant Infrmatin Applicant Name- Last First Current Street Address Unit City State Zip Applicant Date: Western Management supprts the spirit and intent f all lcal, state and federal fair husing laws fr all residents withut regard t clr, race, religin, sex, marital status, mental r physical disability, age, familial status, sexual rientatin, r natinal rigin.

Western Management PO Box San Jose, California

Western Management PO Box San Jose, California Fax COMMUNITY NAME PROPERTY MANAGER FROM FAX PAGES PHONE DATE REGARDING Rental Applicatin CC Urgent Fr Review Please Cmment Please Reply Please Recycle Cmments: Western Management PO Bx 26824 San Jse,

More information

PERKINS REALTY RENTAL PROCEDURES

PERKINS REALTY RENTAL PROCEDURES PERKINS REALTY RENTAL PROCEDURES PERKINS REALTY DOES BUSINESS IN ACCORDANCE WITH THE FAIR HOUSING ACT, AND DOES NOT DISCRIMINATE ON THE BASIS OF SEX, SEXUAL ORIENTATION, MARTIAL STATUS, RACE, CREED, RELIGION,

More information

Application Instructions Effective February 8, 2013

Application Instructions Effective February 8, 2013 Applicatin Instructins Effective February 8, 2013 D Step 1. Dwnlad and review the Admissins & Occupancy Plicy fr the prperty yu are interested in. Step 2. Dwnlad and print a cpy f the Applicatin Packet

More information

Workforce Housing Qualification Guidelines

Workforce Housing Qualification Guidelines Wrkfrce Husing Qualificatin Guidelines Prime Real Estate, LLC cmplies with the Federal Fair Husing Act. Prime Real Estate, LLC des nt discriminate n the basis f race, clr, religin, natinal rigin, sex,

More information

PRIMERO RE-2 SCHOOL DISTRICT SUPERINTENDENT/PRINCIPAL APPLICATION. Mission

PRIMERO RE-2 SCHOOL DISTRICT SUPERINTENDENT/PRINCIPAL APPLICATION. Mission Missin The Primer RE-2 Schl District shall strive t prvide a safe envirnment, fr all students and staff and meaningful pprtunities and innvative educatinal prgrams fr all students s that they reach their

More information

HOUSEHOLD MEMBERS (please include head of household)

HOUSEHOLD MEMBERS (please include head of household) Date: ST. TAMMANY PARISH COMMUNITY ACTION AGENCY WAP Applicatin Last Name: First Name: Address: City: Zip Cde Telephne Number: Cell: MARITAL STATUS: Single (Never Married) Married Separated Divrced Widwed

More information

OAKVIEW CONDOMINIUM ASSOC INC.

OAKVIEW CONDOMINIUM ASSOC INC. Versin UPD: 10/2/17 OAKVIEW CONDOMINIUM ASSOC INC. APPLICATION FOR LEASE/ PURCHASE INSTRUCTIONS Nn Refundable Applicatin Fee f $100.00 Husband & Wife r Parent/Dependent Child. Any applicant applying as

More information

Karuk Tribe Housing Authority Application & Checklist

Karuk Tribe Housing Authority Application & Checklist Karuk Tribe Husing Authrity Applicatin & Checklist Please make sure that all infrmatin in this applicatin is accurate. The applicatin must be cmpleted in full and all the attachments must be submitted

More information

Application for Employment (Please print)

Application for Employment (Please print) Crdage Cmmerce Center 10 Crdage Park Circle Suite 208 Plymuth, MA 02360 WWW.THEARCOFGP.ORG Email:Inf@Thearcfgp.rg PHONE: 508.732.9292 FAX: 508.732.9229 Applicatin fr Emplyment (Please print) Name Last

More information

APPLICATION OF EMPLOYMENT FOR PRINCIPAL ASSISTANT PRINCIPAL TEACHER

APPLICATION OF EMPLOYMENT FOR PRINCIPAL ASSISTANT PRINCIPAL TEACHER APPLICATION OF EMPLOYMENT FOR PRINCIPAL ASSISTANT PRINCIPAL TEACHER Applicatins are accepted nly fr pen psitins ****Please cmplete, print, sign and mail r e-mail t the schl where yu are applying. 1 Thank

More information

Tenancy Application Form

Tenancy Application Form Tenancy Applicatin Frm Applicatins will nly be prcessed nce this applicatin is fully cmpleted. Shuld the applicant fail t prvide the fllwing details the applicatin will nt be prcessed. If yur applicatin

More information

Renewal of Manager s Certificate

Renewal of Manager s Certificate Applicatin fr Renewal f Manager s Certificate Sectin 219, Sale and Supply f Alchl Act 2012 General infrmatin: Yu must renew yur manager s certificate befre it expires. Once yur manager s certificate has

More information

VOLUNTEER REGISTRATION FORM

VOLUNTEER REGISTRATION FORM VOLUNTEER REGISTRATION FORM Office Use Only Prgram: Site: Day(s): Time: Name Email: Phne Number (cell) (hme) (Wrk) Address Birth date What is yur current ccupatin? Are yu r have yu ever been a member f

More information

Caregiver/Respite Application (Please print)

Caregiver/Respite Application (Please print) 52 Armstrng Rad Plymuth, MA 02360 WWW.THEARCOFGP.ORG Email:Inf@Thearcfgp.rg PHONE: 508.732.9292 FAX: 508.732.9229 Caregiver/Respite Applicatin (Please print) Name Last First Middle Address Street City

More information

APPLICATION FOR RESIDENTIAL TENANCY

APPLICATION FOR RESIDENTIAL TENANCY Head ffice: 7/29 Cllier Rad, Mrley WA 6062 (08) 9207 2088 Wangara ffice: 1/7 Prindiville Dr, Wangara WA 6065 (08) 9409 7577 admin@xceedre.cm.au 1. PROPERTY DETAILS APPLICATION FOR RESIDENTIAL TENANCY PROPERTY

More information

All applicants and listed vendors must submit a criminal background check valid

All applicants and listed vendors must submit a criminal background check valid AMENDMENT TO APPLICATION Receipt # Receipt # Date Submitted Date Submitted Amunt paid Amunt paid COMMERCIAL VENDOR APPLICATION PEDDLING, SOLICITING, SPECIAL EVENT VENDOR, VENDOR AT ATHLETIC EVENT Chapter

More information

Mentoring & Coaching

Mentoring & Coaching Mentring and Caching Interventin Preventin Prgrams Mentring Caching Mentr Applicatin Prcess Rles and Respnsibilities Our Mentring Caching Prgram strives t develp a strng bnd and a cnsistent relatinship

More information

COLLEGE HOUSING NORTHWEST RENTAL APPLICATION

COLLEGE HOUSING NORTHWEST RENTAL APPLICATION COLLEGE HOUSING NORTHWEST RENTAL APPLICATION Cllege Husing Nrthwest is a nt-fr-prfit rganizatin funded in 1969 by students t supprt students in the areas f husing, academic success, and persnal develpment.

More information

Consent to Request Consumer Report & Investigative Consumer Report Information

Consent to Request Consumer Report & Investigative Consumer Report Information Cnsent t Request Cnsumer Reprt & Investigative Cnsumer Reprt Infrmatin Applicant's First Name r Initial Last Name I understand that [Cmpany Name] ( COMPANY ) will utilize the services f Sterling InfSystems

More information

Notice all applicants applying to live at NeighborWorks Alaska s Apartments

Notice all applicants applying to live at NeighborWorks Alaska s Apartments Ntice all applicants applying t live at NeighbrWrks Alaska s Apartments Effective September 1, 2016, All f NeighbrWrks Alaska s prperties listed belw will be smke free. In rder t eliminate the knwn health

More information

Instruction Page. Verification of 2014 Income Information for Individuals with Unusual Circumstances

Instruction Page. Verification of 2014 Income Information for Individuals with Unusual Circumstances Instructin Page Imprtant Nte: Please ntify the financial aid ffice if the student r their parents had a change in marital status after the end f the 2014 tax year n December 31, 2014 and als if the parents

More information

ASETS APPLICATION. Are you receiving Income Support. Name Age Date of Birth Relationship Living with me. Emergency

ASETS APPLICATION. Are you receiving Income Support. Name Age Date of Birth Relationship Living with me. Emergency Inuvialuit Reginal Crpratin Human Resurces, Educatin & Training Department ASETS Prgram 867-777-7091 Tll Free: 1-855-777-7011 Fax: 867-777-4506 CRF EI PERSONAL IDENTIFICATION SIN Surname ASETS APPLICATION

More information

REPRESENTATIVE PAYEE PROGRAM T. O. D., Inc.

REPRESENTATIVE PAYEE PROGRAM T. O. D., Inc. P.O. Bx 99243 Referral Checklist Client Infrmatin: Please cmplete t the best f yur ability adding as many details as available. Budget: The budget shuld be filled ut as cmpletely as pssible. If yu are

More information

Application for Rent-Geared-to-Income Assistance Form 1 (Part 1)

Application for Rent-Geared-to-Income Assistance Form 1 (Part 1) Applicatin fr Rent-Geared-t-Incme Assistance: Applicatin fr Rent-Geared-t-Incme Assistance Frm 1 (Part 1) Instructins 1. Please print, and fill ut all sectins f the applicatin frm. Yu will find infrmatin

More information

EMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Box 398 ATT: Human Resources Fort Myers, Florida (239)

EMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Box 398 ATT: Human Resources Fort Myers, Florida (239) PERSONAL INFORMATION EMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Bx 398 ATT: Human Resurces Frt Myers, Flrida 33902 (239) 533-2245 http://www.lee-cunty.cm JOB NUMBER: JOB TITLE: EXAM ID#: Received:

More information

National Background Check Permission Forms

National Background Check Permission Forms Natinal Backgrund Check Permissin Frms Purpse: Frm t btain a backgrund web search fr an emplyee/vlunteer wh has resided utside the state f Indiana in the previus ten years. 1. Emplyee/vlunteer must cmplete

More information

REFERENCE NUMBER: PFS.PDS.115. TITLE: Patient Billing and Collections CURRENT EFFECTIVE DATE: 01/01/2018. PAGE 1 of 8 SCOPE:

REFERENCE NUMBER: PFS.PDS.115. TITLE: Patient Billing and Collections CURRENT EFFECTIVE DATE: 01/01/2018. PAGE 1 of 8 SCOPE: PAGE 1 f 8 SCOPE: This Patient Billing and Cllectins Plicy applies t all Presbyterian Healthcare Services (Presbyterian) hspital facilities, including inpatient, utpatient, hme health care services and

More information

PREPARING TO TERMINATE DROP

PREPARING TO TERMINATE DROP PREPARING TO TERMINATE DROP If yu wrk until yur riginal Deferred Retirement Optin Prgram (DROP) terminatin date, the Divisin f Retirement will mail yu yur DROP Terminatin Packet apprximately 90 days prir

More information

Grant Application Guidelines

Grant Application Guidelines Grant Applicatin Guidelines The prgram staff f the Cmmunity Fundatin f Greater New Britain lks frward t wrking with yu. This frm is fr rganizatins that have submitted a Letter f Intent t us and were invited

More information

ApplicantCare is an online application and candidate management tool that automates the hiring process.

ApplicantCare is an online application and candidate management tool that automates the hiring process. Plicy Overview It is the plicy f Kelis t prvide equal emplyment pprtunities. Emplyment decisins and actins will be cnducted withut regard t gender, sexual rientatin, race, clr, age, natinal rigin, ancestry,

More information

ILLINOIS INSTITUTE OF TECHNOLOGY J-1 SCHOLAR REQUEST FORM (TO BE COMPLETED BY THE SCHOLAR)

ILLINOIS INSTITUTE OF TECHNOLOGY J-1 SCHOLAR REQUEST FORM (TO BE COMPLETED BY THE SCHOLAR) J-1 SCHOLAR REQUEST FORM (TO BE COMPLETED BY THE SCHOLAR) Please cmplete this frm and return it t yur hst department as sn as pssible s that we may issue yu a DS-2019, which is used when yu apply fr a

More information

Guide to Young Adult Dependent Coverage

Guide to Young Adult Dependent Coverage Guide t Yung Adult Dependent Cverage The New Yrk State Legislature passed a law in 2009 which extends the availability f health insurance cverage t yung adults thrugh the age f 29. As a result, Freelancers

More information

HOME IMPROVEMENT CONTRACT

HOME IMPROVEMENT CONTRACT HOME IMPROVEMENT CONTRACT YOU ARE ENTITLED TO A COMPLETELY FILLED-IN COPY OF THIS CONTRACT, SIGNED BY BOTH YOU AND THE CONTRACTOR BEFORE ANY WORK MAY BE STARTED. CONTRACTOR S NAME: ADDRESS: PHONE: FAX:

More information

Employment Application. Name: Last First Middle. Home ( ) Alternate( ) Type: i.e. cell phone, message, etc. Social Security No.

Employment Application. Name: Last First Middle. Home ( ) Alternate( ) Type: i.e. cell phone, message, etc. Social Security No. Tribal Lending Enterprise (TLE) a whlly wned Crpratin f the Habematlel Pm f Upper Lake 635 B E. Hwy 20 Upper Lake, CA 95485-0516 7300 Cllege Blvd., Ste. 650, Overland Park, KS 66210 D: (913) 717-4664 TF:

More information

Checking and Savings Account Application

Checking and Savings Account Application Checking and Savings Accunt Applicatin Please use the Checking and Savings Accunt Applicatin t: Open a FREE Checking r Dividend Checking and Opt-in r Out f DCU s Overdraft Payment Service including an

More information

Golf Relief and Assistance Fund Application

Golf Relief and Assistance Fund Application Glf Relief and Assistance Fund Applicatin Eligibility The Glf Relief and Assistance Fund is designed t supprt individuals wrking in the glf industry and their husehld family members wh have been impacted

More information

Verification Worksheet- V1 DIRECTIONS 2016 INCOME TAX FILER DIRECTIONS:

Verification Worksheet- V1 DIRECTIONS 2016 INCOME TAX FILER DIRECTIONS: 2018-2019 Verificatin Wrksheet- V1 DIRECTIONS 2016 INCOME Yur applicatin was selected by the U.S. Dept. f Educatin fr review in a prcess called "verificatin". Yu must submit the last 3 pages f this verificatin

More information

Institute For Orthopaedic Surgery (IOS) Subject: Billing and Payments: General Guidelines

Institute For Orthopaedic Surgery (IOS) Subject: Billing and Payments: General Guidelines Institute Fr Orthpaedic Surgery (IOS) Plicy and Prcedure Manual Subject: Billing and Payment: General Statements Purpse: T prvide directin t staff members in their interactin with patients and guarantrs

More information

The Safety Net Foundation

The Safety Net Foundation The Safety Net Fundatin Instructins fr Kineret (anakinra) and Sensipar (cinacalcet HCl) Instructins The Safety Net Fundatin prvides temprary prduct assistance t financially needy patients wh meet predetermined

More information

Guide to Reporting Income Changes Online

Guide to Reporting Income Changes Online Guide t Reprting Incme Changes Online This guide is fr MNsure-certified brkers, navigatrs and certified applicatin cunselrs (CACs) t help cnsumers reprt an incme change using the life event change (LEC)

More information

DCU Membership Application Checklist

DCU Membership Application Checklist DCU Membership Applicatin Checklist T speed up the prcessing f yur applicatin, please fllw these steps: 1. Fill ut the applicatin cmpletely and sign it. Incmplete r unsigned applicatins will be returned.

More information

Privacy & Data Protection Policy

Privacy & Data Protection Policy Privacy & Data Prtectin Plicy Whitby & District Fishing Industry Training Schl Limited and 54 Nrth Maritime Training ("Whitby Fishing Schl", WDFITS, 54 Nrth Maritime "we" r "us") are cmmitted t prmting

More information

Town of Palm Beach Retirement System. Deferred Retirement Option Plan (DROP) Policies and Information for Participants

Town of Palm Beach Retirement System. Deferred Retirement Option Plan (DROP) Policies and Information for Participants Twn f Palm Beach Retirement System Deferred Retirement Optin Plan (DROP) Plicies and Infrmatin fr Participants Twn f Palm Beach Retirement System Deferred Retirement Optin Plan (DROP) Plicies and Infrmatin

More information

ISA CERTIFIED ARBORIST APPLICATION

ISA CERTIFIED ARBORIST APPLICATION ISA CERTIFIED ARBORIST APPLICATION This applicatin must be received at least 12 WORKING DAYS prir t the date f the chapter r assciate rganizatin exam fr which yu are applying. There is n deadline fr the

More information

IRS 2016 FEDERAL TAX TRANSCRIPT INFORMATION

IRS 2016 FEDERAL TAX TRANSCRIPT INFORMATION Financial Aid Office P.O. Bx 6905 Radfrd, VA 24142 Phne: (540) 831-5408 Fax: (540) 831-5138 finaid@radfrd.edu RU Financial Aid Website: http://www.radfrd.edu/finaid IRS 2016 FEDERAL TAX TRANSCRIPT INFORMATION

More information

Habitat for Humanity of Greater Memphis Family Selection Requirements

Habitat for Humanity of Greater Memphis Family Selection Requirements Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Habitat fr Humanity f Greater Memphis Family Selectin Requirements First, families are chsen wh are hmeless

More information

address: Driver license number: Date of birth: Occupation:

address: Driver license number: Date of birth: Occupation: MEMBERSHIP APPLICATION PRIMARY MEMBER INFORMATION Name: Scial security Member Number: Hme phne: Cell phne: Business phne: Mther s Maiden Name: Security passwrd: Mailing address: City: State: ZIP Cde: Street

More information

MICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS

MICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS Seattle, Washingtn 98101 MICRO GROUP EMPLOYER DOCUMENTATION REQUIREMENTS D nt cancel any existing plicies until yu receive cnfirmatin f final rates and/r acceptance f the grup by Regence BlueShield (Regence).

More information

Direct Entry Pre-Approval Requirements for Level II Technician Candidates

Direct Entry Pre-Approval Requirements for Level II Technician Candidates Direct Entry Pre-Apprval Requirements fr Level II Technician Candidates The Direct Entry prgram is intended t allw rpe access technicians wh have btained rpe access skills and experience n an industrial

More information

How to reclassify your residency: for US citizens and permanent residents

How to reclassify your residency: for US citizens and permanent residents Hw t reclassify yur residency: fr US citizens and permanent residents When yu first attend UF grad schl, the university waives yur tuitin at the in- state rate fr a year as a grace perid during which yu

More information

CAREVEST MORTGAGE INVESTMENT CORPORATION Directions for Completing Retraction Requests

CAREVEST MORTGAGE INVESTMENT CORPORATION Directions for Completing Retraction Requests This package is ONLY fr Class A sharehlders f. Cntents f this package (5 pages): - Instructins fr cmpleting yur retractin request - Retractin Request frm fr CareVest Mrtgage Investment Crpratin The February

More information

NYTD Survey- 19 year olds

NYTD Survey- 19 year olds 1 The fllwing survey is being dne t recrd yur experience in the West Virginia Fster Care System. Yur respnses are imprtant and we really d want yur input as we try t find ways t imprve Fster Care and create

More information

C>bmeA 9D3-C{r;{ J-I 00;:)"

C>bmeA 9D3-C{r;{ J-I 00;:) Cmmercial Driver Applicatin fr Emplyment Cmpany Name: -Ll,),R Q.[)S PQf't \L\ \ \J --=s uds"')'i'"3=d, State, Zip: \~\'f-.. '---IS C>bmeA 9D3-C{r;{ J-I 00;:)" Q03-Qe,)- 0\0

More information

Subject Access Requests

Subject Access Requests Subject Access Requests The Data Prtectin Act 1998 gives rights t individuals in respect f the persnal data that rganisatins hld abut them. One f thse rights is the right t get a cpy f the infrmatin that

More information

Social Security Administration

Social Security Administration Scial Security Administratin 1329 S. Divisin St. Traverse City MI 49684 September 25, 2018 Clumns & Features Mnthly Infrmatin Package Octber 2018 WORKERS' COMPENSATION AND CERTAIN DISABILITY PAYMENTS MAY

More information

Policy on Requesting Reasonable Accommodations from the Zoning Code

Policy on Requesting Reasonable Accommodations from the Zoning Code Plicy n Requesting Reasnable Accmmdatins frm the Zning Cde Backgrund The Americans with Disabilities Act (ADA), as amended, is a federal anti-discriminatin statute designed t remve barriers that prevent

More information

Petition to Rezone Packet

Petition to Rezone Packet Petitin t Rezne Packet Cntents Prcedure and Required Materials Petitin Applicatin Affidavit Permissin t Reprduce Cnfirmatin f Ownership by Owner; and Authrizatin fr Agent r Petitiner, when a different

More information

STUDENT EMPLOYMENT FORMS PACKET

STUDENT EMPLOYMENT FORMS PACKET STUDENT EMPLOYMENT FORMS PACKET FOR INTERNATIONAL STUDENTS THE GW Center fr Career Services Marvin Center Suite 505 Student emplyment questins? E-mail us at gwse@gwu.edu This packet cntains: Federal I-9

More information

VODACOM BROADBAND FIBRE

VODACOM BROADBAND FIBRE VODACOM BROADBAND FIBRE SECTION A: Custmer Details & Package Selectin Surname First Names ID Number Street Address Estate Suburb City Prvince Phne Number (Hme) Phne Number (Wrk) Phne Number (Cell) Email

More information

BACKGROUND CHECK DISCLOSURE DOCUMENT

BACKGROUND CHECK DISCLOSURE DOCUMENT NOTICE TO SAFESTHIRES CLIENT: The sample dcuments included in this PDF shuld NOT be cnstrued as legal advice, guidance r cunsel. Emplyers shuld cnsult their wn attrney abut their cmpliance respnsibilities

More information

Privacy Notice for Applicants and Tenants

Privacy Notice for Applicants and Tenants Privacy Ntice fr Applicants and Tenants What we need Scttish Brders Husing Assciatin (SBHA) will be a "cntrller" f the persnal infrmatin that yu prvide t us thrugh yur cmpleted Husing Applicatin Frm, and

More information

PLAN DOCUMENT TEMPORARY DISABILITY INSURANCE PROGRAM FOR LAY EMPLOYEES DIOCESE OF METUCHEN OFFICE OF HUMAN RESOURCES. Effective January 1, 2014

PLAN DOCUMENT TEMPORARY DISABILITY INSURANCE PROGRAM FOR LAY EMPLOYEES DIOCESE OF METUCHEN OFFICE OF HUMAN RESOURCES. Effective January 1, 2014 DIOCESE OF METUCHEN OFFICE OF HUMAN RESOURCES TEMPORARY DISABILITY INSURANCE PROGRAM FOR LAY EMPLOYEES PLAN DOCUMENT Effective January 1, 2014 (Replaces January 1, 2013 Plan Dcument) 1 CONTENTS OVERVIEW...

More information

2017 Funding Application Loan Repayment Assistance Program

2017 Funding Application Loan Repayment Assistance Program 2017 Funding Applicatin Lan Repayment Assistance Prgram Lewis & Clark Law Schl Deadline May 30, 2017 Eligibility is based n the factrs in the brchure entitled Overview f the Lan Repayment Assistance Prgram

More information

CLOVER PARK TECHNICAL COLLEGE INTERNATIONAL ADMISSION APPLICATION PACKET

CLOVER PARK TECHNICAL COLLEGE INTERNATIONAL ADMISSION APPLICATION PACKET CLOVER PARK TECHNICAL COLLEGE INTERNATIONAL ADMISSION APPLICATION PACKET 2017-2018 T apply fr admissin, please cmplete the frms belw and submit with the dcuments indicated: FORMS Internatinal Educatin

More information

Newport News Shipbuilding Employee s Hardship Fund

Newport News Shipbuilding Employee s Hardship Fund Newprt News Shipbuilding Emplyee s Hardship Fund Executive Summary Missin: The Newprt News Shipbuilding Emplyees Hardship Fund (the "Fund'') will prvide mnetary supprt t assist emplyees fllwing a natural

More information

The Application is due by Mail: Friday, April 27, 2018 The scholarship applications must be mailed to:

The Application is due by Mail: Friday, April 27, 2018 The scholarship applications must be mailed to: Dear Emma Nylen Schlarship Applicant, Enclsed, yu will find the fllwing: 1) Eligibility Requirements; and 2) Emma Nylen Schlarship Prgram Applicatin Apprximately 20-50 schlarships are prvided thrugh the

More information

APPLICATION FOR ADMISSION 2019

APPLICATION FOR ADMISSION 2019 APPLICATION FOR ADMISSION 2019 APPLICANT INFORMATION Last Name: First Name: Date f Birth: (mnth/day/year) Gender: Male Female Citizenship: Hme Cuntry Address: City: State/Prvince: Pstal Cde: Cuntry: E-mail:

More information

CRG PATIENT REGISTRATION FORM

CRG PATIENT REGISTRATION FORM CRG PATIENT REGISTRATION FORM PATIENT INFORMATION Patient s Name: Birth : (Last) (First) (Middle) Scial Security Number: Male: Female: Hme Address: (Street / RR Bx # / Apt. #) (City/State) (Zip) Preferred

More information

Ramsey Million Partnership

Ramsey Million Partnership Ramsey Millin Partnership General Pints GUIDANCE FOR APPLICATIONS FOR FUNDING GENERAL GRANTS POT 2019 (i) Opening Statement Yur grant applicatin must meet the criteria as established by the Big Lcal and

More information

ILLINOIS INSTITUTE OF TECHNOLOGY J-1 SCHOLAR REQUEST FORM (TO BE COMPLETED BY THE DEPARTMENT)

ILLINOIS INSTITUTE OF TECHNOLOGY J-1 SCHOLAR REQUEST FORM (TO BE COMPLETED BY THE DEPARTMENT) J-1 SCHOLAR REQUEST FORM (TO BE COMPLETED BY THE DEPARTMENT) Please cmplete this frm and return it, alng with the individual s sectin, t the Internatinal Center as sn as pssible s that we may issue the

More information

Certification of Beneficial Owner(s)

Certification of Beneficial Owner(s) GENERAL INSTRUCTIONS T help the gvernment fight financial crime, federal regulatin requires certain financial institutins t btain, verify, and recrd infrmatin abut the beneficial wners f legal entity custmers.

More information

PASSPORT INFORMATION:

PASSPORT INFORMATION: Dear Vlunteers, Thank yu fr yur interest in the Kids Arund the Wrld playgrund build trip. We are excited fr the pprtunity t wrk alngside yu t impact the lives f these children. The need there is tremendus

More information

TRID Rule Purchase For Applications dated on or after 10/3/2015

TRID Rule Purchase For Applications dated on or after 10/3/2015 Fr Applicatins dated n r after 10/3/2015 This dcument prvides a brief verview f the TRID Rule s requirements and specifies the purchase requirements fr CMG Mrtgage, Inc., dba CMG Financial, (CMG). CMG

More information

Parent Guide to Financial Aid

Parent Guide to Financial Aid Parent Guide t Financial Aid fr the 2019-20 schl year OVERVIEW AND DEADLINES Welcme t the financial aid applicatin seasn fr the 2019-20 schl year. We recgnize that the applicatin prcess can be stressful

More information

Scottish Building Society Mortgage Interest Summary

Scottish Building Society Mortgage Interest Summary 3 Year Discunted Variable Rate Mrtgages fr purchase r remrtgage 1.99% (variable) i.e. SVR less 3.15% 3 Years SVR 4.3% 3% f lan amunt in first 3 years Purchase: Nne 80% - 350,000 70% - 500,000 Other Cmments

More information

VILLAGE OF SCHILLER PARK COOK COUNTY, ILLINOIS

VILLAGE OF SCHILLER PARK COOK COUNTY, ILLINOIS VILLAGE OF SCHILLER PARK COOK COUNTY, ILLINOIS Prcedures and Applicatin fr Village f Schiller Park Cnsideratin f Ck Cunty Real Estate 6B Classificatin This applicatin is nly used fr petitin f a standard

More information

Bread for the City Representative Payee Program Program Guide

Bread for the City Representative Payee Program Program Guide Bread fr the City Representative Payee Prgram Prgram Guide Thank yu fr chsing Bread fr the City t be yur Organizatinal Representative Payee. We hpe that the infrmatin in this guide will help yu. Our address:

More information

FINANCIAL SERVICES GUIDE

FINANCIAL SERVICES GUIDE PART N: iinvest Securities Financial Services Guide (FSG) FINANCIAL SERVICES GUIDE DATED: Octber 2017 Cntents f this FSG This Financial Services Guide ( FSG ) is an imprtant dcument that iinvest Securities

More information

HALE MAHAOLU HOUSING APPLICATION

HALE MAHAOLU HOUSING APPLICATION 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,

More information

Steps toward Retirement

Steps toward Retirement Steps tward Retirement Eligibility, Actin Steps, and Benefit Optins fr Faculty and Staff Nearing Retirement Eligibility fr Official University Retiree Status The fllwing jb types f the University are eligible

More information

PROCESS FOR NATIONAL CAPITOL AREA GARDEN DISTRICTS, CLUBS AND COUNCILS CHOOSING TO FILE FOR 501(C)3 GROUP EXEMPTION

PROCESS FOR NATIONAL CAPITOL AREA GARDEN DISTRICTS, CLUBS AND COUNCILS CHOOSING TO FILE FOR 501(C)3 GROUP EXEMPTION PROCESS FOR NATIONAL CAPITOL AREA GARDEN DISTRICTS, CLUBS AND COUNCILS CHOOSING TO FILE FOR 501(C)3 GROUP EXEMPTION What is a grup exemptin letter? The IRS smetimes recgnizes a grup f rganizatins as tax-exempt

More information

Instructions Fee Schedule

Instructions Fee Schedule City f Lndn Tree Prtectin By-Law C.P.-1515-228 Tree Prtectin Area Permit Applicatin Cemetery r Glf Curse Planning Services - Urban Frestry 267 Dundas Street, 3rd Flr Lndn, Ontari N6A 1H2 Telephne: 519-661-CITY

More information

Verification Worksheet

Verification Worksheet 2015-2016 Verificatin Wrksheet Independent Student Tracking Grup V1 STAFF USE ONLY Frm Received by Date Yur 2015 2016 Free Applicatin fr Federal Student Aid (FAFSA) was selected fr review in a prcess called

More information

B.S.A. TROOP 271. High Adventure Policies

B.S.A. TROOP 271. High Adventure Policies B.S.A. TROOP 271 High Adventure Plicies Purpse Apprval High-adventure trips can be a terrific way t accmplish many f the bjectives f the By Scuts f America, such as develping leadership, character and

More information

Purpose... 1 Definitions... 1 Policy... 2

Purpose... 1 Definitions... 1 Policy... 2 Cntents Purpse... 1 Definitins... 1 Plicy... 2 1. Privacy Principles... 2 2. Cllectin f infrmatin... 2 3. Unique Student Identifiers (USI)... 3 4. Strage and use f infrmatin... 4 5. Disclsure f infrmatin...

More information

FHA OVERLAY MATRIX. A Closing Protection Letter (CPL) is required

FHA OVERLAY MATRIX. A Closing Protection Letter (CPL) is required This dcument is a summary f mst Platinum Hme Mrtgage guideline verlays and FHA requirements. This dcument shuld be used as a reference tl in cnjunctin with the Crrespndent Seller Guide and is nt meant

More information

There are two ways to submit your banking information for direct deposit into your personal bank account:

There are two ways to submit your banking information for direct deposit into your personal bank account: Cmpleting Yur Master Student Financial Assistance (MSFAA) Agreements Alberta and Canada have lifetime Master Student Financial Assistance Agreements (MSFAAs) that will cver yu fr all f the time yu are

More information

Please Note: It is your sole responsibility to review and understand your employer's policies

Please Note: It is your sole responsibility to review and understand your employer's policies MICROSOFT RETAIL EXPERTZONE PROMOTION OFFICIAL RULES Please Nte: It is yur sle respnsibility t review and understand yur emplyer's plicies regarding yur eligibility t participate in trade prmtins such

More information

JOHN L. LITTLE, D.D.S, P.A ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES. May Refuse to Sign This Acknowledgement-

JOHN L. LITTLE, D.D.S, P.A ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES. May Refuse to Sign This Acknowledgement- JOHN L. LITTLE, D.D.S, P.A ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES -Yu I, Privacy Practices. May Refuse t Sign This Acknwledgement- ---, have received a cpy f this ffice's Ntice f {Please

More information

Neighborhood Tool Kit. Office of Neighborhood Vitality City of Mesquite, Texas

Neighborhood Tool Kit. Office of Neighborhood Vitality City of Mesquite, Texas Neighbrhd Tl Kit Office f Neighbrhd Vitality City f Mesquite, Texas TABLE OF CONTENTS Tpic Page Neighbrhd Rles and Respnsibilities............................................. 1 Starting A Neighbrhd Grup....................................................

More information

PATIENT LIABILITY STATEMENT

PATIENT LIABILITY STATEMENT PATIENT LIABILITY STATEMENT (Updated 6/17) We will nt initiate therapeutic services until signed authrizatin is prvided. I understand that I am persnally respnsible fr charges incurred fr services rendered

More information

ABORIGINAL ECONOMIC PARTNERSHIPS Program Application Guidelines

ABORIGINAL ECONOMIC PARTNERSHIPS Program Application Guidelines ABORIGINAL ECONOMIC PARTNERSHIPS Prgram Applicatin Guidelines The Abriginal Ecnmic Partnerships Prgram (AEPP) supprts Abriginal cmmunities, businesses and rganizatins t increase participatin in ecnmic

More information

Private Lesson Paperwork Checklist

Private Lesson Paperwork Checklist 2018-19 Private Lessn Paperwrk Checklist Please cmplete the fllwing frms t be eligible t teach as a Private Lessn Instructr fr 2018/19. General Infrmatin Frm Cnsent t Perfrm Criminal Histry Backgrund Check

More information

NATIONWIDE BUILDING SOCIETY COMMUNITY GRANTS

NATIONWIDE BUILDING SOCIETY COMMUNITY GRANTS NATIONWIDE BUILDING SOCIETY COMMUNITY GRANTS Natinwide Building Sciety was funded t help peple int hmes f their wn. This Cmmunity Grants prgramme supprts lcal husing prjects in yur area, s even mre peple

More information

Ending Your Membership in the Plan

Ending Your Membership in the Plan Ending Yur Membership in the Plan Yu must be eligible fr a valid disenrllment perid. Yur cverage will end the first day f the mnth after we receive yur request t disenrll. When can yu end yur membership

More information

APPLICATION FORM FOR ASSISTANCE FROM THE AFRICAN WORLD HERITAGE FUND

APPLICATION FORM FOR ASSISTANCE FROM THE AFRICAN WORLD HERITAGE FUND APPLICATION FORM FOR ASSISTANCE FROM THE AFRICAN WORLD HERITAGE FUND This template is the riginal assistance request frm which when sent shuld cver all the questins asked. It can be adjusted t accmmdate

More information

Medical Marijuana Activity Zoning Ordinance SUPPLEMENTAL APPLICATION PACKET Manufacturing

Medical Marijuana Activity Zoning Ordinance SUPPLEMENTAL APPLICATION PACKET Manufacturing Medical Marijuana Activity Zning Ordinance SUPPLEMENTAL APPLICATION PACKET Manufacturing COMMUNITY DEVELOPMENT DEPARTMENT / PLANNING DIVISION 8130 Allisn Avenue, La Mesa, CA 91942 Phne: 619.667.1177 Fax:

More information

Sewer Blockage Procedure

Sewer Blockage Procedure Sewer Blckage Prcedure I N F O R M A T I O N F O R P L U M B E R S J U N E 2 0 1 7 When a blckage is identified in the sewer Huse Cnnectin Branch (HCB) we will review the issue and in sme circumstances:

More information

Siding Program Application

Siding Program Application Siding Prgram Applicatin Please read the attached Plicy Guidelines and prvide the requested infrmatin. 1. Address f Prperty: 2. Applicant s name & mailing address: Telephne: ( ) - E-mail 3. Applying fr:

More information

Workers' Compensation Employee's Guide

Workers' Compensation Employee's Guide Wrkers' Cmpensatin Emplyee's Guide Intrductin What is Wrkers' Cmpensatin? What is a Wrk-Related Injury? Wh Is Cvered by the UCSD Wrkers' Cmpensatin Prgram and When? Where D Yu Receive Initial Medical Treatment?

More information