VILLAGE OAKS Pre-APPLICATION For Project-Based Section 8 Units Incomplete applications will not be accepted: This application is for Project-Based Section 8 (income-based) units at Village Oaks Apartments, which is located on the 3600 block of West 18 th Avenue in Eugene, Oregon. Subsidies are provided for one and twobedroom units. Applicants need to meet very-low income guidelines. See the back of this application for income limits. Applications may be returned to our Springfield office by mail, fax, or in person. If you would like help in filling out this application, we can assist you by providing a note taker, interpreter, someone to read, larger print, or other reasonable accommodations. Does any adult on your application claim a disability or is age 62 or older? Yes No Si usted necesita ayuda en llenar ésta solicitúd, por favor llame a 541-682-4090 y pregunte por la traductora. Si necesita Usted servicios idioma de español para aplicar para viviendas? Si No APPLICANT/FAMILY INFORMATION: Applicant Mailing Address Primary Phone Number Cell Number Message Number PRINT CLEARLY THE NAMES OF EVERYONE WHO WILL BE LIVING IN RENTAL UNIT, INCLUDING APPLICANT Completing the Race or Ethnicity Code is voluntary. The information is collected for civil rights purposes and the information will not be used in determining an applicant s eligibility. If you prefer, a separate form for completing the Race or Ethnicity section will be provided to you. Please attach a separate sheet of paper if additional space is needed to add more family members. At least one member of the household must be an eligible U.S. Citizen. Name Relationship Date of Birth SELF US Citizen Yes or No Sex Social Security Number Race and Ethnicity Race: White; Black or African American; American Indian or Alaskan Native; Asian; Hawaiian/Pacific Islander. Ethnicity: H if Hispanic Is any member in the household required to register as a Lifetime Registered Sex Offender in ANY state? YES NO Has any household member been evicted from federally assisted housing in the past 3 years for drugrelated criminal activity? YES NO Please list all states in which all adults have lived:
HOUSEHOLD INCOME: Household Income (Approximate): List family member receiving income, gross amount, how often, and source example: wages, child support, social security, unemployment, TANF. Family Member Amount Frequency of Payment Source of Income Village Oaks Income Guidelines Applicants need to meet Very-Low Income guidelines. Forty-percent of all new admissions must meet Extremely-Low Income guidelines. Very Low and Extremely Low Income Limits Project-Based Units Number in Household 1 2 3 4 5 6 7 8 Very Low Income $22,450 $25,650 $28,850 $32,050 $34,650 $37,200 $39,750 $42,350 Extremely-Low $13,500 $16,460 $20,780 $25,100 $29,420 $33,740 $38,060 $42,350 Village Oaks Apartments offer clean, safe affordable units in a well-maintained complex. Units are equipped with ductless heat pumps that provide air conditioning in the summer. Village Oaks has off-street parking, onsite laundry facilities, and playgrounds. Village Oaks is close to schools, shopping and bus routes. A small dog or cat is permitted with an approved pet application and a $200 deposit. Applicants may apply for a Reasonable Accommodation for an assistance animal. Applicants must pass landlord reference and criminal history background checks. Applicants who have not previously rented, or who have not rented in the last three years, will have the opportunity to provide alternative references showing they will pay rent on time, take good care of the unit, and get along well with neighbors. If you have a disability and need special features (such as visible emergency alarms, grab bars in bathroom, ramps, etc.), or a modification of program rules, policies, or procedures, or a change in the way we communicate with you or give you information, you may ask for this kind of change, which is called Reasonable Accommodation. You may pick up a Request for Reasonable Accommodation from our office or download it from our website at www.homesforgood.org. I understand this is not a contract, but a pre-application for the Village Oaks Apartments. This application does not guarantee that I will receive housing assistance. I swear that the information given on this application is correct and complete to the best of my knowledge. I understand that it is a crime to give false information and may result in the loss/denial of assistance. I authorize the release of information, and authorize Homes for Good to obtain information about me or my family that is pertinent to eligibility for, or participation in, assisted housing programs. Homes for Good may also give my name and address to other housing organizations to aid me in obtaining housing. The information given above may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal or regulatory investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of Homes for Good, except as permitted or required by law. Signature (Head of Household/Primary Applicant) Signature (Other Adult in Household) Date Date
RESIDENTIAL HISTORY WORKSHEET Start with where you live now and go back at least THREE YEARS FROM THIS MONTH. List all residences, including apartments, living with parents, shelters, buying a home, and homelessness. We will verify the owner of the property through tax records and contact the person/company listed, so please be accurate. START WITH YOUR CURRENT RESIDENCE Current Address: Fax RESIDENCE PRIOR TO WHERE YOU LIVE NOW Date Moved Out: (Mo /Yr) (Mo/Yr) Date Moved Out:
Current Address: Fax Date Moved Out: (Mo /Yr) (Mo/Yr) Date Moved Out:
AUTHORIZATION for the Release of Information Organization requesting release of information: Homes for Good Housing Agency 300 W Fairview Dr Springfield, OR 97477 Phone: (541) 682-4090 FAX: (541) 682-3875 Purpose The Homes for Good Housing Agency may use this authorization and the information obtained with it to administer and enforce program rules and policies. Authorization I authorize the release of any information (including documentation and other materials) pertinent to eligibility for or participation under any of the following programs: Low Income Rental Housing Rental Assistance Program (RAP) Section 8 Housing Assistance Payments Shelter Plus Care Program I authorize the above named organization to obtain information about me or my family that is pertinent to eligibility for or participation in housing programs and to obtain information on wages or unemployment compensation from State Employment Securities Agencies. Information Covered Inquiries may be made about: Child Care Expenses Credit History Criminal Activity Family Composition Employment, Income, Pensions & Assets Federal, State, Tribal, or Local Benefits Handicapped Assistance Expenses Identity & Marital Status Internet Income Medical Expenses Social Security Numbers Residences & Rental History HOMES FOR GOOD HOUSING AGENCY This form cannot be used to request a copy of a tax return. Instead, use IRS form 4506, Request for a Copy of Tax Form. Individual or Organizations That May Release Information: Any individual or organization, including any governmental organization, may be asked to release information. For example, information may be requested from: Banks and Other Financial Institutions Courts Law Enforcement Agencies Credit Bureaus Employers, Past and Present Internet Services Landlords Providers of: Alimony Child Care Child Support Credit Schools & Colleges U.S. Social Security Administration U.S. Department of Veterans Affairs Utility Companies Welfare Agencies Computer Matching Notices & Consent Handicapped Assistance Medical Care Pensions Annuities I agree that a Public Housing Agency or Indian Housing Authority may conduct computer matching programs with other governmental agencies including Federal, State, Tribal or local agencies. These agencies include, but are not limited to: Enterprise Income Verification (EIV) U.S. Office of Personnel Management U.S. Social Security Administration U.S. Department of Defense U.S. Postal Service State Welfare and Food Stamp Agencies The Work Number State Employment Agencies The match will be used to verify information supplied by the family. Conditions I/We agree that photocopies of this authorization may be used for the purposes stated above. The original of this authorization is on file with Homes for Good and will stay in effect for a year and one month from the date signed. If I/we do not sign this authorization, I/we understand that my/our housing application may be denied or terminated. Signatures Head of Household Print Name Date Adult Member Print Name Date Adult Member Print Name Date