Boulevard Apartments - Father Joe's Villages

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                                                                                                           Wait List Request/ Pre‐Application  LOCATION OF HOUSING DESIRED:   16 th  & Market Workforce/Affordable Housing  640 Market Street  Boulevard Apartments  3137 El Cajon Boulevard  DESIRED HOUSEHOLD BEDROOM SIZE:             1br          2br         3br     PLEASE FILL OUT COMPLETELY PRINT LEGIBLY, THEN SIGN AND DATE ON PAGE TWO OF THIS FORM Current Mailing Address    Apt/Unit #  Home Phone    Page 4 of 5       First Name      Middle Name  For Office Use Only  Date/Time Stamp Here:              Last Name  City  State  Zip Code    Work Phone  Best Time for Contact  Applicants will be contacted periodically in order to update the building’s waiting list.  S.V.D.P. Management, Inc. will  call or mail a  notice to each person on the waiting list at the time of the update.  Failure to respond to these updates will cause the Applicant’s  name to be removed from the waiting list.  Please provide an alternate contact, below, such as a relative or a close friend where we  can leave a message for you. First Name  Last Name    Mailing Address    Apt/Unit #  Home Phone      HOUSEHOLD INFORMATION Approximate Amount of Annual income before Taxes  $ _______________________________  Do You have a Section 8 Voucher?   Yes    No      City  State  Zip Code    Work Phone  Best Time for Contact  Total Number of persons in your household    Adults _________  + Children__________ Total = ________    Indicate if any member of your household is a person with   a disability.    If disabled, please specify:   Hearing  Mobility  Vision  Other __________________________________  Will you or anyone in your household require a Wheel chair Accessible Unit?    Yes     No     Do you require a Live‐in Attendant?    Yes    No     (If you require a wheelchair accessible unit or a live‐in attendant, you must provide written verification from a licensed provider.)  Are you homeless (living in a shelter or transitional housing)?  Yes   No  Are you a veteran?  Yes  No  How did you hear about the wait list opening for 16 th  and Market Workforce/Affordable Housing or Boulevard Apartments?    Newspaper    Flyer     Relative/Friend     News/Radio     Other____________________________________________   
  Certification of Applicant  Please read carefully.  By signing you are agreeing  to the following terms:  I hereby certify that the information I have provided in this Wait List Request/ Pre‐Application is true and accurate.   I understand that:  My application  is considered conditionally eligible for housing based solely on statements given in this wait list  request/pre‐application form;  This is not an offer for housing and my position on the waiting list does not assure me or anyone in my household housing  at 16th and Market Workforce/Affordable Housing or Boulevard Apartments;  It is my responsibility to report all application information changes (i.e. family composition or size, income, assets, social  security numbers, etc.), as this may have an impact on my eligibility based on federal housing regulations and S.V.D.P  Management, Inc. policy and that my failure to do so may affect my place on the waiting list;  It is my responsibility to notify S.V.D.P Property Management, Inc. of any changes to my contact information.   I will be asked to sign forms that will be sent out to verify the information given on my application, i.e., income, asset  information, homeless or  disability status, prior to any offer of a unit.    Intentionally providing false information is considered fraud and can result in severe penalties, including, but not limited to,  loss of my place on the waiting list;     All information provided on the pre‐application and application will be verified.  False, inaccurate or incomplete  information may disqualify me;  S.V.D.P. Management, Inc. will complete third party verifications for certification and verify that I meet the minimum and  maximum income guidelines.    Applicant’s Signature:___________________________________    Date:__________________________    THIS SECTION FOR OFFICE USE ONLY       AREA MEDIAN INCOME : 30%       40%        50%         60%   SPECIAL NEEDS:    YES   NO  HOUSING LOCATION CHOSEN:     16 th  & Market     Boulevard  HOUSEHOLD BEDROOM SIZE :            1br          2br         3br       Student Rule requirements have been reviewed      Additional notes: ___________________________________________________________________________________    Applicant Screened by: __________________________________________________  Date: ______________________      Page 5 of 5    
Page 1 and 2:     Opening February 2009
Page 3: INCOME AND OTHER ELIGIBILITY REQUIR

Boulevard Apartments - Father Joe's Villages

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