Habitat for Humanity of Greater Memphis Family Selection Requirements

Size: px
Start display at page:

Download "Habitat for Humanity of Greater Memphis Family Selection Requirements"

Transcription

1 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 r living in inadequate r substandard cnditins. Such circumstances may be caused by vercrwding r by deplrable physical cnditins f the dwelling. Other factrs that wuld cause living cnditins t be deemed inadequate r substandard will als receive cnsideratin. Husing which represents an excessive cst burden (mre than 30% f a family s grss mnthly incme) is cnsidered substandard. Next, families must be in the lw t very lw incme tax bracket. (Lw incme is defined as thse husehlds earning less than 80% f Shelby Cunty median incme per husehld, based n family size, and which wuld prevent the family frm btaining mrtgage financing frm a bank r ther traditinal mrtgage lender.) We screen applicants fr stability f incme and credit t determine their ability and willingness t pay the mnthly payments n the nn-prfit, n-interest mrtgage prvided by Habitat fr Humanity f Greater Memphis t its hmebuyers Incme Guidelines: Family Size Grss Annual Incme Range 1 $12,650 - $33,700 2 $14,450 - $38,500 3 $16,250 - $43,300 4 $18,050 - $48,100 5 $19,500 - $51,950 6 $20,950 - $55,800 7 $22,400 - $59,650 8 $23,850 - $63,500 Families must als be willing t fulfill the requirements f the Habitat hmewnership prgram by cmpleting a mandatry hmebuyer educatin and pst purchase prgrams. Finally, families are required t cmplete three hundred fifty (350) hurs in sweat equity, which can be earned by building their huse, anther Habitat hmewner s huse, r ther cmmunity service apprved by Habitat. Families must be gd stewards f their hme and their hew hmewner status by making mnthly payments n time, maintaining the physical upkeep f the prperty, including the lawn, being mindful f and aviding predatry lenders, and abstaining frm increased debt lad during their participatin in the Habitat Hmewnership Prgram. 1

2 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Habitat fr Humanity f Greater Memphis Qualificatin Guidelines Please nte that the fllwing circumstances will result in a denial f yur applicatin. Applicant r c-applicant has had an wnership interest in real prperty (including timeshare wnership) within the past three years. Applicant r c-applicant has had a freclsure r given a deed in lieu f freclsure within the past fur years. Applicant r c-applicant has unpaid tax liens, medical bills, cllectins accunts, r judgments shwing n their credit reprt. Applicant r c-applicant is presently in bankruptcy. (Prir Chapter 7 bankruptcies must have been discharged a minimum f tw years prir t applicatin, and acceptable credit must have been re-established. Prir Chapter 13 bankruptcies must have been discharged a minimum f ne year prir t applicatin, and all payments under the plan must have been made, and acceptable credit must have been re-established). Inaccurate, incmplete, materially misleading, r false infrmatin is prvided n the applicatin r during the applicatin prcess. Must have a 2 year wrk histry. Gaps in emplyment ver 30 days will require a written explanatin. Criminal histry is als cnsidered in ur evaluatin f a family s suitability and eligibility fr the Habitat Hmewnership Prgram. Any histry f felny, drug, weapns, sexual, r vilent ffenses (including arrests and/r cnvictins), may cnstitute grunds fr denial f an applicatin. Habitat fr Humanity f Greater Memphis is pledged t the letter and spirit f the U.S. plicy fr the achievement f equal husing pprtunity thrughut the natin. We encurage and supprt an affirmative advertising and marketing prgram in which there are n barriers t btaining husing because f race, clr, religin, sex, handicap, familial status, r natinal rigin. Habitat fr Humanity f Greater Memphis is an equal pprtunity emplyer. 2

3 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Applicatin Checklist: All f the items listed belw MUST be returned with yur applicatin. The fully cmpleted applicatin with all signatures. A mney rder r cash fr $25.00, payable t Habitat fr Humanity f Greater Memphis, t cver yur applicatin fee. Three frms f identificatin (drivers license, birth certificate, and scial security card) fr every persn wh will ccupy the Habitat hme fr which yu are applying. Yur mst recent paycheck stub with year t date earnings. (If the applicant is selfemplyed, we require the past tw years tax returns with all schedules and a year t date prfit and lss statement). This is required fr every persn ver the age f 18 wh will ccupy the Habitat hme fr which yu are applying. Yur 2015 r 2016 (After January 2017 if yu have them) tax return, all pages and with all W-2s and 1099 s (If self-emplyed, tw years tax returns must be prvided). The mst recent Scial Security award letters fr any individual wh will ccupy the Habitat hme fr which yu are applying that receives Scial Security benefits. If child supprt is being received r, if yu are required t pay child supprt, we must be prvided the case number r a printut frm the curt clerk r TN child supprt prgram shwing that all required supprt has been received r paid fr a perid f at least ne year withut interruptin. Acknwledgment/Cnsent t Sex Offender Registry search fr every individual wh will ccupy the Habitat hme wh is ver the age f 18. Bank statements (all pages) fr the tw mnths immediately preceding the mnth in which the applicatin is made (fr applicant and c-applicant). Please nte: Incmplete applicatins will be rejected. In the event that an incmplete applicatin is accepted in errr, it will nt be prcessed until cmplete. 3

4 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Applicant: Date f Birth: Phne Number: ( ) Scial Security N.: Alternate Phne Number: address: Address: Zip Prir Addresses: (if at current address less than 2 years): Emplyer Name and Address: Phne: Hw lng: Jb Title: Previus emplyers and dates f emplyment (if at present jb fr less than tw years): Are yu a veteran? D yu have a disability? Marital Status (circle ne): Single Married Separated Divrced Highest Grade/Degree cmpleted C-Applicant: Date f Birth: Phne Number: ( ) Scial Security N.: Alternate Phne Number: address: Address: Prir Addresses: (if at current address less than 2 years): Emplyer Name and Address: Phne: Hw lng: Jb Title: Previus emplyers and dates f emplyment (if at present jb fr less than tw years): Are yu a veteran? D yu have a disability? Highest Grade/Degree cmpleted: Marital Status (circle ne): Single Married Separated Divrced 4

5 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 HOUSING INFORMATION: Current hme size: Bedrms Bathrms Number f persns living in yur current hme: Are yu hmeless? Yes/N (circle ne) Are yu living in a part f anther family s hme? Yes/N (circle ne) Explain, if needed: Are yu receiving Sectin 8 r living in public husing? Current hme cnditins: (circle the apprpriate respnse, and explain in the prvided space) Overcrwded? Yes/N Structural prblems? Yes/N Envirnmental issues? Yes/N (pr insulatin, nn-functining heat r air cnditining, pr indr air quality) Safety cncerns? Yes/N Electrical/Plumbing issues? Yes/N Present landlrd name: Phne Number: Fax Number: Current mnthly rent: $ hw much d YOU pay? Current mnthly utilities: $ hw much d YOU pay? 5

6 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Previus landlrd name (if less than 2 years at present address) Phne Number: Fax Number: HOUSEHOLD INFORMATION: Number f individuals wh will ccupy the hme: Individuals wh will ccupy the hme: Name Age Male/Female Relatinship t Applicant Mnthly Expense Infrmatin: We will perfrm a preliminary evaluatin f yur ability t make mnthly payments n the zer-percent mrtgage ffered via the Habitat Hmewnership Prgram. Infrmatin n yur husehld s mnthly expenses is essential t this determinatin. Please nte that if yu are deemed eligible fr the prgram, yu will be asked t cmplete a lan applicatin, and additinal incme and expense infrmatin may be required frm yu at that time, r frm time t time, as yu prceed with the applicatin and apprval prcess. Car payment (if any) $ Child care $ Health insurance $ Cable/internet $ Cell phne $ Credit cards $ Car Insurance $ Utilities $ Other: 6

7 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Incme Infrmatin: Many f Habitat s hmebuilding activities are funded by grants which require that we serve nly lwincme persns. In rder that we may cmply with the requirements f the grants under which we perate, we are required t determine the GROSS MONTHLY HOUSEHOLD INCOME (befre taxes) f the individuals wh intend t ccupy the Habitat hme. All individuals ver the age f 18 wh d nt wrk will be required t sign an Affidavit f N Incme. Incme Type Applicant C-Applicant Dependents ver 18 Mnthly Base salary Overtime (2 yr. avg.) Scial Security Incme Child Supprt Other TOTALS Lcatin Preference: Habitat fr Humanity f Greater Memphis builds hmes in a variety f lcatins. Please rank yur husing lcatin preference using the fllwing scale: 1 = mst desirable; 2 = less desirable, but acceptable; 3 = nt interested. Winchester/Tchulahma Area Winchester/Mendenhall Area Uptwn Memphis Nrthaven Bingham/Pershing Area Raleigh Area Hlmes/Weaver Area Nrth Memphis Habitat cannt guarantee that hmes r building lts will be available in any particular area at any particular time. Hwever, prviding this infrmatin will help us plan ur upcming cnstructin prjects and will als help us t accmmdate yur lcatin preference where we are able t d s. 7

8 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Certificatin and Authrizatin By signing this applicatin fr the Habitat fr Humanity hmewnership prgram, I/we certify that: I/we have nt held an wnership interest in real prperty within the past three years; I/we am/are willing t cmplete the required Hmebuyer Educatin prgram presented by Habitat; I/we am/are willing and able t cmplete the required sweat equity (350 hurs fr a sle applicant, and 400 hurs fr a jint applicatin); I/we understand that the Habitat hmewnership prgram requires prspective hmewners t make a $1,000 dwn payment n their hme and save a $1,000 emergency fund befre they can clse n the purchase f their hme, and I am/we are able t cmply with these requirements. All infrmatin cntained n this applicatin is true and cmplete. I/we understand that any false, incmplete, materially misleading r inaccurate infrmatin n this applicatin may result in denial f my/ur applicatin. I/we understand that in prcessing my/ur applicatin and evaluating my/ur suitability and eligibility fr the Habitat hmewnership prgram, Habitat will perfrm a sex ffender registry check, a credit check, and a criminal backgrund check, and that Habitat will als verify my/ur rent, emplyment and incme with my/ur emplyers and landlrds. Habitat may als cntact my prir landlrds fr a reference. I/we authrize Habitat fr Humanity f Greater Memphis t receive and independently verify the infrmatin cntained in my/ur applicatin and attachments and t perfrm the backgrund, credit, sex ffender, and criminal checks as stated abve in rder t evaluate my/ur eligibility and suitability fr the Habitat hmewnership prgram. NOTICE: This applicatin package is submitted t Habitat fr Humanity f Greater Memphis as the first step in qualifying fr ur hmewnership prgram. It is nt a lan applicatin. If yu are apprved fr the Habitat hmewnership prgram, yu will be required t cmplete and sign a Unifrm Residential Lan Applicatin. During the prcessing f yur applicatin t the hmewnership prgram, additinal infrmatin may be requested frm time t time, in rder t satisfy ur family selectin guidelines. Any requested infrmatin must be prvided within 30 days f ur written request, r yur applicatin will be cnsidered withdrawn. Date: Date: Applicant signature C-applicant signature Applicatin received by: Date: Habitat fr Humanity f Greater Memphis is pledged t the letter and spirit f the U.S. plicy fr the achievement f equal husing pprtunity thrughut the natin. We encurage and supprt an affirmative advertising and marketing prgram in which there are n barriers t btaining husing because f race, clr, religin, sex, handicap, familial status, r natinal rigin. Habitat fr Humanity f Greater Memphis is an equal pprtunity emplyer. 8

9 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Habitat fr Humanity f Greater Memphis Sexual Offender Registry and Criminal Backgrund Check Plicy fr Partner Families and Husehld Members Purpse- Plicy- As a ministry, Habitat fr Humanity f Greater Memphis (HFHGM) values the safety f children, ur emplyees, vlunteers, and the families we serve. We want t take prudent measures t prtect ur human and material resurces. HFHGM requires that Sex Offender Registry and criminal backgrund checks be cnducted fr all adult members f ptential Partner Families. HFHGM reserves the right t recheck sex ffender and/r criminal backgrund status at any time during the qualificatin prcess, hmebuilding prcess, and during any ccupancy f the prperty by a Partner Family prir t the clsing f the purchase f the Habitat hme by the Partner Family. Disqualificatin Criteria- A Sex Offender Registry r criminal backgrund finding may disqualify an applicant frm hmewnership with HFHGM. In determining eligibility, HFHGM, in its sle discretin, may cnsider several factrs, including withut limitatin, ne r mre f the fllwing: The nature f the cnvictin and whether children were invlved; The amunt f time elapsed since the ffense; The extent t which the ffense may affect the persn s fitness r ability t cmplete the requirements f the hmewnership prgram; The age f the individual when the ffense ccurred; The number f cnvictins (if mre than ne); Whether partnering with the applicant and/r candidate wuld pse a risk f legal liability t the rganizatin; The extent t which the individual has made an effrt twards rehabilitatin since the cnvictin; Whether the ffense is f a type which is likely t have an impact n hmewners living in the immediate vicinity (such as drug ffenses); Whether the crime invlved vilence r weapns; 9

10 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Whether the state s public plicy encurages hmewnership by persns wh have been cnvicted f crimes; and Any ther factr that HFHGM deems relevant t the decisin. Effect f Failure t Prvide Infrmatin: If any applicant, member f an applicant s husehld, r member f a Partner Family s husehld withhlds r falsifies infrmatin pertaining t a sex r criminal ffense, the persn may be disqualified frm further cnsideratin. Examples where Disqualificatin Warranted Sme examples f ffenses fr which HFHGM may, within its sle discretin, determine that an individual r Partner Family is ineligible fr hmewnership include, but are nt limited t: Serius felny cnvictins; Offenses invlving the manufacture r distributin f illegal substances; Weapns ffenses; Child abuse ffenses; Dmestic vilence cnvictins; Child mlestatin; Statutry rape; Cnvictin fr an ffense related t child prngraphy; and/r Sexual assault cnvictin, including frcible rape. This abve list is nt exhaustive and is prvided fr illustrative purpses nly. HFHGM reserves the right t weigh disqualificatin criteria n a case-by-case basis and t make selectin and deselectin decisins in its sle discretin. Disqualificatins may extend t any partner family member. 10

11 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 I/we acknwledge receipt f a cpy f Habitat fr Humanity f Greater Memphis s Sex Offender Registry and Criminal Backgrund Check plicy and cnsent t having my/ur name(s) checked in the Sex Offender Registry. Applicant Name: Scial Security N. Date f birth: Gender: Other names/aliases previusly used: Current Address: Previus Address/States: Have yu ever been cnvicted f, r d yu have any pending charges invlving criminal r sexual ffenses? (If yes, please explain. Cntinue explanatin n the back f this page, if necessary.) Signature: Date : C-Applicant Name: Scial Security N. Date f birth: Gender: Other names/aliases previusly used: Current Address: Previus Address/States: Have yu ever been cnvicted f, r d yu have any pending charges invlving criminal r sexual ffenses? (If yes, please explain. Cntinue explanatin n the back f this page, if necessary.) Signature: Date : 11

12 Habitat fr Humanity f Greater Memphis Hmewnership Prgram Applicatin Package Revised Dec 2016 Hmewner Applicant Vluntary Infrmatin The fllwing infrmatin is requested by the Federal gvernment fr lans related t the purchase f hmes, in rder t mnitr the Lender's cmpliance with the equal credit pprtunity and fair husing laws. Yu are nt required t furnish this infrmatin, but are encuraged t d s. The law prvides that a Lender may neither discriminate n the basis f this infrmatin, nr n whether yu chse t nt furnish it. Hwever, if yu chse nt t furnish it, under federal regulatins this lender is required t nte race and sex n the basis f visual bservatin r surname. If yu d nt wish t furnish the abve infrmatin, please check the bx belw. (Lender must review the abve material t assure the disclsures satisfy all requirements t which the Lender is subject under applicable state law fr the lan applied fr.) Race: I d nt wish t furnish this infrmatin. American Indian r Alaskan Native Asian White Native Hawaiian/Pacific Islander Black r African American American Indian r Alaska Native & White Asian & White Black r African American & White American Indian/Alaska Native & Black/African American Other Multi-Racial (specify) Ethnicity: Sex: Hispanic r Latin Nn Hispanic r Latin Female Male T be cmpleted by Affiliate: This Applicatin was taken by: Received by (print r type name) Face t face interview Mail Telephne Signature Date We are pledged t the letter and spirit f the U.S. plicy fr the achievement f equal husing pprtunity thrughut the natin. We encurage and supprt an affirmative advertising and marketing prgram in which there are n barriers t btaining husing because f race, clr, religin, sex, handicap, familial status, r natinal rigin." 12

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

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

Western Management 1654 The Alameda Suite 100 San Jose, California

Western Management 1654 The Alameda Suite 100 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 1654 The Alameda Suite

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Understanding Loan Product Advisor s Determination of Total Monthly Debt for Conventional Loans

Understanding Loan Product Advisor s Determination of Total Monthly Debt for Conventional Loans Understanding Lan Prduct Advisr s Determinatin f Ttal Mnthly As indicated in Freddie Mac s Single-Family Seller/Servicer Guide (Guide) Sectin 5401.2, the Brrwer's liabilities must be reflected n the Mrtgage

More information

HABITAT FOR HUMANITY OF GREATER BANGOR (HFHGB) FAMILY SERVICES

HABITAT FOR HUMANITY OF GREATER BANGOR (HFHGB) FAMILY SERVICES HABITAT FOR HUMANITY OF GREATER BANGOR (HFHGB) FAMILY SERVICES POLICIES AND PROCEDURES 1.0 PARTNERSHIP Successful partnerships are built upn hnesty, trust, mutual respect, and a cperative, willing attitude.

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

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

Information Package CAFETERIA 125 PLANS

Information Package CAFETERIA 125 PLANS Infrmatin Package CAFETERIA 125 PLANS Shaffer Insurance Services, Inc. Benefits Divisin 902 E. Ave Q-9 Palmdale Ca. 93550 Tll Free (866) 412-5872 Office Tel (661) 575 9331 Fax (661) 280 2016 Sectin 125

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

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

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

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

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

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

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

HOC Works Program Requirements

HOC Works Program Requirements HOC Wrks Prgram Requirements Last Revisin: March 2018 INTRODUCTION The Husing Opprtunities Cmmissin f Mntgmery Cunty (HOC) established the HOC Wrks prgram in 2015 in rder t guarantee that HOC emplyment

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

CITY OF MASSILLON, OHIO FY 2014 Community Development Block Grant Program Application for Project Funding

CITY OF MASSILLON, OHIO FY 2014 Community Development Block Grant Program Application for Project Funding 1. Prject Name CITY OF MASSILLON, OHIO FY 2014 Cmmunity Develpment Blck Grant Prgram Applicatin fr Prject Funding 2. Cmmunity Develpment Blck Grant Fund (CDBG) Request Ttal FY 2014 CDBG funds request:

More information

Attachment G. Homeownership Opportunities Program (HOP) Guidelines

Attachment G. Homeownership Opportunities Program (HOP) Guidelines . Hmewnership Opprtunities Prgram (HOP) Guidelines Cntents: 1: Prgram Descriptin 2: Member Participatin and Registratin 3: Funding Use, Limits, and Availability 4: Member Requirements 5: Recipient Requirements

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

APPLICATION FOR CONCESSIONAL FEES

APPLICATION FOR CONCESSIONAL FEES APPLICATION FOR CONCESSIONAL FEES Family Name: Family Number: Students Enrlled at Sacred Heart Cllege: Name Year Level Checklist I/We have fr all carers: Cmpleted and Signed this Applicatin Attached the

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

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

Special Conditions Form

Special Conditions Form 2017-18 Special Cnditins Frm Cntact Infrmatin www.twsn.edu/finaid finaid@twsn.edu 410-704-4236 If yur family has experienced a majr reductin in incme, the Financial Aid Office may be able t reevaluate

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

Special Conditions Form

Special Conditions Form 2019-2020 Special Cnditins Frm Cntact Infrmatin www.twsn.edu/finaid finaid@twsn.edu 410-704-4236 If yur family has experienced a majr reductin in incme, the Financial Aid Office may be able t reevaluate

More information

Assistance Program: Prince George s County, Maryland Pathway to Purchase First Time Homebuyers Assistance Code: DMDPRINCE

Assistance Program: Prince George s County, Maryland Pathway to Purchase First Time Homebuyers Assistance Code: DMDPRINCE Assistance Prgram: Prince Gerge s Cunty, Maryland Pathway t Purchase First Time Hmebuyers Assistance Cde: DMDPRINCE HOMEOWNERSHIP ASSISTANCE PROGRAM SUMMARY Prduct Descriptin Allwable Originatin Channel

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

Employee Hardship Assistance Policy

Employee Hardship Assistance Policy Emplyee Hardship Assistance Plicy Functinal Area: Human Resurces Applies T: All Faculty and Staff Plicy Reference(s): N/A Number: TBD Date Issued: March 4, 2013 Page(s): 6 Respnsible Persn The Directr

More information

Details of Rate, Fee and Other Cost Information

Details of Rate, Fee and Other Cost Information Details f Rate, Fee and Other Cst Infrmatin Accunt terms are nt guaranteed fr any perid f time. All terms, including fees and APRs fr new transactins, may change in accrdance with the Credit Card Agreement

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

APPLICATION TO CHANGE OR ADD A CORPORATE OFFICER OF A CORPORATION OR MEMBER / MANAGER OF A LIMITED LIABILITY COMPANY. General Instructions

APPLICATION TO CHANGE OR ADD A CORPORATE OFFICER OF A CORPORATION OR MEMBER / MANAGER OF A LIMITED LIABILITY COMPANY. General Instructions NEVADA STATE CONTRACTORS BOARD 2310 Crprate Circle, Suite 200, Hendersn Nevada, 89074 (702) 486-1100 Fax (702) 486-1190 Investigatins (702) 486-1110 5390 Kietzke Lane, Suite 102, Ren, Nevada, 89511 (775)

More information

YUM! Brands 401k Plan

YUM! Brands 401k Plan YUM! Brands 401k Plan Final Distributin Electin Name: Scial Security #: Address: Daytime Telephne #: Evening Telephne #: Befre yu can prcess a Final Distributin Electin, yur status must be terminated.

More information

(as of 12/11/09) A borrower (the current owner) may be able to avoid a foreclosure by completing a short sale or a deedin-lieu

(as of 12/11/09) A borrower (the current owner) may be able to avoid a foreclosure by completing a short sale or a deedin-lieu (as f 12/11/09) 1. What is HAFA? Initially annunced n May 14, 2009, with guidance and standard frms issued n Nvember 30, 2009, the prgram will help wners (referred t belw as brrwers) wh are unable t retain

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

Business Income & Expenses Part II

Business Income & Expenses Part II Chapter 4 Business Incme & Expenses Part II Rental and vacatin prperties Passive incme/lsses Deductins fr AGI Individual Retirement Accunts (IRAs) Other retirement plans Rllver rules 1 Rental Incme/Expenses

More information

Attachment C. Monitoring Procedures

Attachment C. Monitoring Procedures Attachment C. Mnitring Prcedures These prcedures set frth the prcess that the Federal Hme Lan Bank f Indianaplis ( FHLBI r the Bank ) fllws in mnitring its Affrdable Husing Prgram (AHP) cmpetitive applicatin

More information

Financial Aid Satisfactory Academic Progress Appeal Request Spring 2019 Deadline: January 3, 2019

Financial Aid Satisfactory Academic Progress Appeal Request Spring 2019 Deadline: January 3, 2019 Financial Aid 2018-2019 Satisfactry Academic Prgress Appeal Request Spring 2019 Deadline: January 3, 2019 Is this yur first appeal? (Currently n Financial Aid Suspensin) Is this yur secnd appeal? (Appeal

More information

MAINTENANCE Domestic Relations Law 236-B(5-a) & (6) For divorces filed after January 25, a. Temporary maintenance awards.

MAINTENANCE Domestic Relations Law 236-B(5-a) & (6) For divorces filed after January 25, a. Temporary maintenance awards. MAINTENANCE Dmestic Relatins Law 236-B(5-a) & (6) Fr divrces filed after January 25, 2016 5-a. Temprary maintenance awards. a. Except where the parties have entered int an agreement prviding fr maintenance

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

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

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

HOUSING APPLICATION 223 South Winnebago Street Rockford, IL (815)

HOUSING APPLICATION 223 South Winnebago Street Rockford, IL (815) HOUSING APPLICATION 223 Suth Winnebag Street Rckfrd, IL 61102 (815) 489-8500 APPLICANT NAME The cmplexes listed belw are currently accepting applicatins. Yu must be 18 years f age t apply fr husing. Failure

More information

Small Business Sustainability Program Payment Application Instructions/Process

Small Business Sustainability Program Payment Application Instructions/Process Small Business Sustainability Prgram Payment Applicatin Instructins/Prcess Eligibility Requirements 1. Business must be lcated in the active cnstructin znes n Alum Rck Avenue between Highway 101 and Interstate

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

Quality Assurance Program Independent Student Verification Worksheet

Quality Assurance Program Independent Student Verification Worksheet 2015-16 Quality Assurance Prgram Independent Student Verificatin Wrksheet QAIVER Yur applicatin was selected fr review in a prcess called verificatin. In this prcess, Temple University will be cmparing

More information

Mod Rehab Annual Review forms packet

Mod Rehab Annual Review forms packet Md Rehab Annual Review frms packet Indicates frms included in the Md Rehab Annual Review frms packet. Agencies r applicants supply the ther materials listed. SRO Persnal Declaratin SHA Release f Infrmatin

More information

City of Laramie/Albany County Community Partner Organization-- Outside Agency Funding Request Application. Fiscal Year 2018/2019

City of Laramie/Albany County Community Partner Organization-- Outside Agency Funding Request Application. Fiscal Year 2018/2019 City f Laramie/Albany Cunty Cmmunity Partner Organizatin-- Outside Agency Funding Request Applicatin Fiscal Year 2018/2019 Intrductin The City f Laramie and Albany Cunty prvide funding pprtunities t lcal

More information

Attachment H. Neighborhood Impact Program (NIP) Guidelines

Attachment H. Neighborhood Impact Program (NIP) Guidelines Attachment H. Neighbrhd Impact Prgram (NIP) Guidelines Cntents: 1: Prgram Descriptin 2: Member Participatin and Registratin 3: Funding Use, Limits, and Availability 4: Member Requirements 5: Recipient

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

UBC Properties Trust (UBCPT) Restricted Faculty Second Mortgage Loan Program Summary of Key Terms. November 1, 2013

UBC Properties Trust (UBCPT) Restricted Faculty Second Mortgage Loan Program Summary of Key Terms. November 1, 2013 UBC Prperties Trust (UBCPT) Restricted Faculty Secnd Mrtgage Lan Prgram Summary f Key Terms Nvember 1, 2013 The Prgram is intended t assist full-time tenured and tenure-track faculty at UBC's Vancuver

More information

TWU OFFICE OF RESEARCH & SPONSORED PROGRAMS INSTRUCTIONS FOR USING THE TWU PROPOSAL APPROVAL ROUTING FORM

TWU OFFICE OF RESEARCH & SPONSORED PROGRAMS INSTRUCTIONS FOR USING THE TWU PROPOSAL APPROVAL ROUTING FORM TWU OFFICE OF RESEARCH & SPONSORED PROGRAMS INSTRUCTIONS FOR USING THE TWU PROPOSAL APPROVAL ROUTING FORM Phne: (940) 898-3375 Website: http://www.twu.edu/research/ WHEN TO SUBMIT THROUGH RESEARCH & SPONSORED

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

EOFY tax strategies for small businesses

EOFY tax strategies for small businesses As we apprach the end f the financial year (EOFY), there are a number f smart strategies yu culd cnsider t help yu streamline yur finances and legitimately save n yur tax bill. Insurance premiums Sme insurance

More information

FLORIDA SMALL BUSINESS EMERGENCY BRIDGE LOAN APPLICATION

FLORIDA SMALL BUSINESS EMERGENCY BRIDGE LOAN APPLICATION FLORIDA SMALL BUSINESS EMERGENCY BRIDGE LOAN APPLICATION Disaster Event: Hurricane Michael (Applicatin Deadline December 7, 2018) LOAN AMOUNT REQUESTED: (Maximum $50,000) * Lans f up t $100,000 may be

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

Partner Agency Application Toque Campaign 2017/18

Partner Agency Application Toque Campaign 2017/18 Partner Agency Applicatin Tque Campaign 2017/18 Allcatin f Tque Campaign Funds Partner Agencies receive 50% f the sale price f each item they sell (example: $7.50 frm every $15.00 tque). Apprximately 40%

More information

Special Circumstance Review

Special Circumstance Review 1 f 7 Student s Name: Last First SLU Banner ID Number 2008-2009 Special Circumstance Review Parent(s)/Stepparent(s) and Student/Spuse may use this frm t reprt significant changes that have ccurred since

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

Informational Sheet- Application for Pension

Informational Sheet- Application for Pension 33 Plaza La Prensa, Santa Fe, NM 87507 (505) 476-9401 Fax (505)476-9300 Vice (800) 342-3422 Tll-Free www.nmpera.rg Infrmatinal Sheet- Applicatin fr Pensin If yu are cnsidering retiring, PERA requests that

More information

NEIGHBORHOOD HOUSING & DEVELOPMENT CORPORATION 633 NW 8 TH AVE. GAINESVILLE, FL TELEPHONE (352) FAX (352)

NEIGHBORHOOD HOUSING & DEVELOPMENT CORPORATION 633 NW 8 TH AVE. GAINESVILLE, FL TELEPHONE (352) FAX (352) NEIGHBORHOOD HOUSING & DEVELOPMENT CORPORATION 633 NW 8 TH AVE. GAINESVILLE, FL 32601 TELEPHONE (352)380-9119 FAX (352)380-9170 WWW.GNHDC.ORG Dear Prspective Hmewner: Thank yu fr cnsidering Neighbrhd Husing

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

Hawaii Division of Financial Institutions 2018 Renewal Checklist

Hawaii Division of Financial Institutions 2018 Renewal Checklist Hawaii Divisin f Financial Institutins 2018 Renewal Checklist Instructins Renewal requests must be submitted thrugh by the date specified by yur state regulatr(s). Click here t review all renewal deadlines,

More information

How to Count Employees Determining Group Size Under the Medicare Secondary Payer Regulations

How to Count Employees Determining Group Size Under the Medicare Secondary Payer Regulations Hw t Cunt Emplyees Determining Grup Size Under the Medicare Secndary Payer Regulatins 1. Wh is an Emplyee? An emplyee is an individual wh wrks fr an emplyer r an individual wh, althugh nt actually wrking

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

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

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

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

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

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

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

Special Circumstance Review 1 of 8

Special Circumstance Review 1 of 8 A Student s Name: 2009-2010 Special Circumstance Review 1 f 8 SLU Banner ID Number Saint Luis University, as allwed by law, cnsiders life changes that ccur after the cmpletin f yur Free Applicatin f Federal

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

How Do I Apply for a Total and Permanent Disability Discharge of My FEDERAL* Student Loans?

How Do I Apply for a Total and Permanent Disability Discharge of My FEDERAL* Student Loans? Hw D I Apply fr a Ttal and Permanent Disability Discharge f My FEDERAL* Student Lans? Ttal and Permanent Disability Discharge fr Federal Student Lans O O SAMPLE DISCHARGE APPLICATION SAMPLE DISCHARGE

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

EXXONMOBIL SAVINGS PLAN Hardship Withdrawal Form

EXXONMOBIL SAVINGS PLAN Hardship Withdrawal Form EXXONMOBIL SAVINGS PLAN Hardship Withdrawal Frm Name: Sc. Sec #: Wrk Phne: ( ) Hme Phne ( ) Yu may request a hardship withdrawal when yur financial need cannt be met thrugh: Reimbursement r cmpensatin

More information

You can get help from government organizations that are not connected with us

You can get help from government organizations that are not connected with us 2011 Evidence f Cverage fr Medi-Pak Advantage MA (PFFS) Chapter 9: What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints) BACKGROUND SECTION 1 Intrductin Sectin 1.1 What t d if

More information