Thank you for contacting Jane Place Neighborhood Sustainability Initiative regarding rental availabilities at 2739 Palmyra Street. The first step in the process is to complete the enclosed application." About JPNSI Jane Place Neighborhood Sustainability Initiative is a housing and community development nonprofit committed to creating sustainable, democratic, and economically just neighborhoods and communities. JPNSI works to increase the range of affordable housing options available to low-income residents by encouraging resident-controlled development, and promoting communitybuilding initiatives that advance equitable housing patterns, neighborhood stability, and community-driven land-use planning. Eligibility: Eligibility for an apartment is determined by the household information provided in this application. The term household in this application refers to all residents who will be living in the unit. JPNSI will collect third party verification of income and asset sources, and check references. Pre-tax (gross) annual income for the household may not exceed 60% of the Area Median Income (AMI). You must have the demonstrated ability to afford to pay the rent. All income and assets are considered. Our aim is that you will not spend more than 30% of your resources on living expenses (rent & utilities). Family Size 1 2 3 4 5 6 Highest Income Eligible (60% AMI) N/A $28,800 $32,400 $36,000 $38,888 $41,775 JPNSI reserves the option to conduct a criminal background check, though a criminal record will not immediately disqualify an applicant from consideration. Please see attached background check policy. Ex-offenders are encouraged to apply.! JPNSI will process applications in order of date received and will be in contact if you are selected for an interview. If selected for an interview, JPNSI will provide you with a list of required documentation. All household members will be required to provide proof of identification and all adults will be required to provide proof of income.
Move-in Process: If your application is approved and you accept an apartment, you will be required to: Sign a Rental Agreement in which you agree to abide by all regulations of tenancy. Tenants are required to pay a security deposit equal to one month s rent. If paying the security deposit in one up-front sum is a financial burden, you may be allowed to pay the deposit in installments together with your first three (3) monthly rent payments. Tenants are required to pay the first month s rent in advance. Tenants are required to have all applicable utilities placed in their names immediately upon acquiring the unit. Instructions: Read this application carefully and provide all necessary information including names, complete mailing addresses, and telephone numbers that apply to the entire household. This application is also available online at www.jpnsi.org All adult household members must sign the application. If you need to request assistance in filling out this application, please contact us at 504-484-9576 or email us at leasing@jpnsi.org. Completed applications can be mailed to: PO Box 53011 c/o JPNSI New Orleans, LA 70153. How did you hear about the Palmyra Apartments? Radio/Newspaper Friend or Family Member Email Flier Referral from Employer Other: PERSONAL INFORMATION! APPLICANT Name(Last) (First) CO-APPLICANT Name(Last) (First) DOB DOB Address City State Zip Address City State Zip Best phone number to reach you at Is this (circle): Home Work Cell Best time to call Best phone number to reach you at Is this (circle): Home Work Cell Best time to call
HOUSEHOLD INFORMATION (please list everyone that will be living in the apartment)! NAME RELATIONSHIP TO APPLICANT DATE OF BIRTH SELF! CURRENT LIVING SITUATION! Do you rent? (circle) Yes No If Yes, who is your landlord Landlord s phone Landlord s address Monthly payment Do you own a home? (circle) Yes No Do you live with others? (circle) Yes No If Yes, explain your living arrangements " " PREVIOUS RENTAL HISTORY (please list all the places you ve lived in the past three (3) years, including your present housing)! 1. Dates you lived there Address Landlord s name Landlord s phone Reason for leaving " 2. Dates you lived there Address Landlord s name Landlord s phone Reason for leaving "
3. Dates you lived there Address Landlord s name Landlord s phone Reason for leaving " EMPLOYMENT INCOME (Please list employment income for each household member over 18 years of age including full-time, part-time, and seasonal employment. Be sure to list pre-tax (gross) monthly amounts and where the income comes from.)! Household Member Name Employer name Employer address Employer phone Estimated gross monthly income Household Member Name Employer name Employer address Employer phone Estimated gross monthly income Household Member Name Employer name Employer address Employer phone Estimated gross monthly income Household Member Name Employer name Employer address Employer phone Estimated gross monthly income OTHER SOURCES OF INCOME (Please list all other sources of income for any household member over 18 years of age, including current gross Social Security monthly amount. If anyone receives Social Security, SSI and/or disability payments, you will be required to provide an award letter.) Household Member Name Pension $ Child Support $ Social Security Benefits $ Supplemental Security Income (SSI) $ Household Member Name Pension $ Child Support $ Social Security Benefits $ Supplemental Security Income (SSI) $
OTHER SOURCES OF INCOME (Continued) Household Member Name Household Member Name Disability of Death Benefits $ Disability of Death Benefits $ Unemployment Benefits $ Unemployment Benefits $ Self Employed $ Self Employed $ Other (Specify) $ Other (Specify) $ Other (Specify) $ Other (Specify) $ Please describe any special circumstances that might change your household income in the future: " " ASSETS: Bank Accounts (Please list all checking and savings accounts held by each person who will live in your apartment, including IRAs, Keogh accounts, and Certifications of Deposit.) Name of account holder Bank name Bank address Type of account: Checking, Savings, IRA, Other... Type of account Current Balance Type of account Current Balance Type of account Current Balance Name of account holder Bank name Bank address Type of account: Checking, Savings, IRA, Other... Type of account Current Balance Type of account Current Balance Type of account Current Balance
ASSETS: Other Assets (Please list all stocks, bonds, trusts, pensions or other assets and their value owned by any adult household member.) Name of asset holder Type of account: Bonds, shares, stocks, 401k, Other Type of account Value Type of account Value Other property owned Name of asset holder Type of account: Bonds, shares, stocks, 401k, Other Type of account Value Type of account Value Other property owned GENERAL INFORMATION If offered an apartment, will the apartment serve as your only residence? Yes No Are you displaced or in danger of being displaced due to domestic violence? Yes No" Are you displaced or in danger of being displaced due to another reason? Yes No Have you or any member of your household been a full-time student in the past year or plan to enroll as a full-time student in the upcoming year? Yes No Are all members of the household citizens of the United States or non-citizens with eligible immigration status? Yes No Do you currently have a Section 8 Housing Choice Voucher (HCV)? Yes No If No, are you on the waiting list for a Section 8 HCV? Yes No Have you previously worked, lived, or had family in the Mid-City neighborhood?" Yes No If Yes, please explain " Why do you want to move to this property? " "
GENERAL INFORMATION (Continued) Do you have any pets?* Yes No Do you or any members of your household smoke?* Yes No *This property does not allow pets or smoking. REFERENCES (Please provide two non-related references who have known you for at least 1 year.) 1. Name Relationship Phone Email 2. Name Relationship Phone Email EMERGENCY CONTACT (Please provide the name of any family or friends we may contact if we are unable to reach you.) Name Relationship Phone Email APPLICANT CERTIFICATION I/we authorize JPNSI, Inc. and/or Management to verify all information provided on this application and to contact previous or current landlords, or other sources of credit and information verification, which may be released to appropriate Federal, State, or local agencies. I/ we certify that the statements made in this application are true and complete to the best of my/ our knowledge and belief. Applicant Signature Date Co-applicant Signature Date
RACE AND ETHNICITY PERSONAL INFORMATION " " The information regarding race, ethnicity, and gender solicited on this application is requested in order to assure the Federal Government, acting through the US Department of Housing and Urban Development, that JPNSI complies with all federal laws prohibiting discrimination against prospective tenants on the basis of race, color, national origin, religion, sex, familial status, and disability. You are not required to furnish this information. This information will not be used in evaluating your application or to discriminate against you in any way. Ethnicity of Applicant Hispanic or Latino Non-Hispanic or Latino Gender of Applicant Female Male Other Race of Applicant Black/African American Asian White Alaska Native or Native American/Indian Native Hawaiian or Other Pacific Islander" Other Marital Status of Applicant Single Married Divorced Widowed Married but Separated Other