Family Housing Applications

Family Application For Admission

INFORMATION SOLICITED ON THIS APPLICATION IS REQUESTED BY THE APARTMENT OWNER IN ORDER TO ASSURE THE GOVERNMENT THAT FEDERAL NEW YORK AND STATE LAWS PROHIBITING DISCRIMINATION AGAINST TENANT APPLICATIONS ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, RELIGION, SEX MARITAL STATUS, AGE AND HANDICAP ARE COMPLIED WITH. THIS INFORMATION WILL NOT BE USED TO DISCRIMINATE AGAINST YOU.

Please respond to all questions on this form as appropriate. If the application is for more than one person be sure to answer all questions for any household member who is on the application.

Download the Family Housing Application (PDF) if you would like to print out and mail the completed application to Christopher Community, Inc.

NYS Fair Housing Notice (PDF)
NYS Housing and Anti-Discrimination Disclosure Form (PDF)

WHAT AREA ARE YOU INTERESTED IN*

West North South No preference

Please select up to 4 properties

Property 1

Property 2

Property 3

Property 4

A

Head of Household Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Email

Telephone Number*

Telephone Messages

Best Time To Contact You

B

How many persons will be living in the apartment? *

Name*

DOB*

Age*

Social Security #*

Name*

DOB*

Age*

Social Security #*

Name

DOB

Age

Social Security #*

Name

DOB

Age

Social Security #*

Name

DOB

Age

Social Security #*

Please enter the Name, Date of Birth, Age, and SSN# for each person who will be living in the apartment

C

Are you or any household member employed? *

Yes No

Employer's Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Phone

Is there another member of the household who is employed?

Yes No

Employer's Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Phone

D

Present Income

Social Secuity payment per month $

Supplemental Security income per month $

Pension income per month $

Gross Employment income per month $

Public Assistance income per month $

Unemployment Assistance $

Child Support $

Other (Explain source) $

E

Current Bank Account Balance

Checking account $

Savings Account $

Money Market account $

Other accounts $

F

Assets

Full value of stocks $

Full value of bonds $

Full value of CD's $

Market value of Real Estate $

Full value of other $

G

Present Living Accomodations

Own House or Mobile Home Rental Housing Public Housing Boarding House Living with Relatives Hotel/Motel Living with Friends

Other:

please check as appropriate

How long have you lived at your residence?

What is your monthly rent, including utilities?

H

Name of Your Present Landlord

First Name

Last Name

Address of Your Present Landlord

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number of Your Present Landlord

Have you had other landlords in the last 5 years?

Yes No

Previous Landlord Name

First Name

Last Name

Previous Landlord Address

Address Line 1

Address Line 2

City

State

ZIP Code

Previous Landlord Phone Number

Have you had other landlords in the last 5 years?

Yes No

Previous Landlord Name

First Name

Last Name

Previous Landlord Address

Address Line 1

Address Line 2

City

State

ZIP Code

Previous Landlord Phone Number

I

Are you presently receiving any form of rent subsidy/certificate?

Yes No

Name of subsidy source

J

Are you on the waiting list of the Syracuse Housing Authority for the Section 8 Rental Assistance?

Yes No

Are you on the Syracuse Housing Authority Apartment Wait List?

Yes No

K

Will your family require an apartment that needs to be equipped to meet any special needs (i.e. such as a wheelchair?)

Yes No

Please list any other accomodations required by your family

L

Please list 3 personal references (who are not relatives)

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

M

Have you or any adult members of your household been convicted of a criminal Offense?

Yes No

Offense?

N

Are you a full time student?

Yes No

School Name

Notice of Occupancy Rights under the Violence Against Women Act

Signature

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