Application

Shinda Management Corporation

SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD.

Learn who should apply, how to apply, and what happens after you apply

Step 1 of 8

Select the building you are applying for:(Required)

1. This information is to be filled out by the applicant

Name(Required)

First Last

Date of Birth(Required)

Social Security Number(Required)

Driver's License Number

Present Address(Required)

Street Address Apt. No. City State ZIP Code

Home Phone No.(Required)

Work Phone No.

Email(Required)

8. Medical Expenses

This allowance is permitted only for households whose HEAD or SPOUSE is age 62 or older, handicapped or disabled. Consider only medical expenses that will not be paid by an outside source e.g., insurance, medicare or grants by State agency or charitable organization.

What are the medical expenses anticipated to be paid by your household in the coming 12 month period?

Will this expense enable an adult member of the household work?

Yes

9. Handicap Expenses

This allowance applies only if a family member is handicapped or disabled. Consider only handicap expenses that will not be paid to a family member living in the household or reimbursed by an outside source such as insurance, medicare or grants by a state agency or charitable organization.

What are the handicap expenses anticipated to be paid by the household in the coming 12 month period?

Will this expense enable an adult member of the household to work?

Yes

10. Child Care Expenses

This allowance applies only to amounts paid for the care of children (including foster children) UNDER AGE 13.

Do you pay for baby-sitting while you or your family work or attend vocational or academic courses?

Yes

Baby-sitter List(Required)

Name

Address

Phone Number

What is the cost of the baby-sitting?(Required)

Per Week

Per Month

11. Persons with Disabilities

In accordance with the Rehabilitation Act of 1973 (504) and the Fair Housing Act, all qualified individuals with handicaps will be given an equal opportunity to receive and enjoy the benefits of living in this housing development. The housing company does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs and activities.

A. Disability

Means a person who:

Has a disability, as defined in 42 U.S.C. 423;

(A) Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months; or

(B) In the case of an individual who has attained the age of 55 and is blind, inability by reason of such blindness to engage in substantial gainful activity requiring skills or abilities comparable to those of any gainful activity in which he/she has previously engaged with some regularity and over a substantial period of time. For the purposes of this definition, the term blindness, as defined in section 416(i)(1) of this title, means central vision acuity of 20/200 or less in the better eye with use of correcting lens. An eye which is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for the purposes of this paragraph as having a central visual activity of 20/200 or less.

Is determined, pursuant to HUD regulations, to have a physical, mental, or emotional impairment that:

(A) Is expected to be of long-continued and indefinite duration;

(B) Substantially impedes his or her disability to live independently, and

Has a development disability, as defined in Section 102(7) of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6001(8)), i.e., a person with a severe chronic disability that:

(A) Is attributable to a mental or physical impairment or combination of mental and physical impairments;

(B) Is manifested before the person attains age 22;

(D) Results in substantial functional limitation in three or more of the following areas of life activity:

a. Self care
b. Receptive and expressive language
c. Learning
d. Mobility
e. Self-direction
f. Capacity for independent living, and
g. Economic self-sufficiency; and

(E) Reflects the person’s need for combination and sequence of special, interdisciplinary, or generic care, treatment or other services that are of lifelong or extended duration and are individually planned and coordinated.

Does not exclude persons who have the disease of acquired immunodeficiency syndrome or any conditions arising from the etiologic agent for acquired immunodeficiency syndrome;
For purposes of qualifying for low-income housing, does not include a person whose disability is based solely on any drug or alcohol dependence; and

Means “individual with handicaps”, as defined in Sec. 8.3 of this title, for purposes of reasonable accommodation and program accessibility for persons with disabilities.

B. Reasonable Accommodations

Is a change, exception, or adjustment to a program, service, building, dwelling unit, or workplace that will allow a qualified person with a disability to:

Participate fully in program;
Take advantage of a service;
Live in dwelling; or
Perform a job.

Reasonable accommodations include, for example, those that are necessary for a person with a disability to use and enjoy a dwelling.

To show that a requested accommodation may be necessary, there must be an identifiable relationship, or nexus, between the requested accommodation and the individual’s disability.

Shown below is our procedure for processing reasonable modification requests for tenants:

a) A written request for a modification to the unit or common area, due to disability, must be submitted to Management by the tenant. The request must include a statement describing the type of modification requested and how it will be beneficial for the applicant/tenant’s effective use of their housing facility.

b) Management will forward an “Acknowledgment” of the request to the tenant within five business days from the date the tenant’s request was received.

c) Within 14 days from the date of Management’s “Acknowledgement” letter, management will send a completed “Modification Request Approval/Disapproval” form to the tenant.

If you are an applicant with a disability and need a reasonable accommodation in order to participate in the application process or to make effective use of the housing program, you have the right to request such an accommodation.

BY SUBMITTING THIS FORM, I DECLARE THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. WARNING: WILLFUL FALSE STATEMENTS OR MISREPRESENTATION ARE A CRIMINAL OFFENSE UNDER SECTION 1001 OF TITLE 18 OF THE U.S. CODE.

PLEASE DO NOT MAIL MORE THAN ONE APPLICATION PER FAMILY. IF MORE THAN ONE APPLICATION IS RECEIVED, THE APPLICATION WILL BE DISQUALIFIED.

12. Authorization of Background Check

It is understood that the premises are to be used as a residence to be occupied by not more than ____ persons and that occupancy subject to possession being delivered by present occupant.

By submitting this form, I hereby authorize Landlord to obtain information it deems desirable in the processing of my application, including; credit reports, civil or criminal actions, rental history, employment/salary details, police and vehicle records and any other relevant information; and release Landlord, its employees and agents from all liability for any damage whatsoever incurred in furnishing or obtaining such information.

Upon approval and acceptance, the applicant agrees to execute a lease before possession I given and to pay the security deposit and the first month’s rent within five days after being notified of acceptance (time being of the essence); failing with application fee shall be retained by Landlord as the agreed compensation for credit investigation, processing and verification of the application, other expenses and/or loss of rent, and the Landlord shall have no further obligation to applicant. In no event is the application fee is refundable to the applicant, except in the event that Landlord fails to deliver possession of the premises as may be required by any lease executed between the parties.

The applicant hereby waives any claim for damages by reason of non-acceptance of this application which the Landlord or his agent may reject without stating reasons for so doing. It is further agreed that if any information herein is false, the lease made on the strength of this application may, at the option of the Landlord, be terminated at any time.

16. Additional Information

Present Address Is(Required)

Present Landlord or Apartment Community(Required)

Name of Bank or Mortgage Company(Required)

Address of Present Landlord / Mortgage(Required)

Street Address Address Line 2 City State ZIP Code

Previous Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Vehicle Make

Vehicle Year

Vehicle License #

Vehicle Registration State

Other Vehicles, Trucks, Boat, Motorcycle, Etc.

Nearest Relative Name(Required)

Nearest Relative Phone(Required)

Nearest Relative Address(Required)

Street Address Address Line 2 City State ZIP Code

Personal Reference Name(Required)

Personal Reference Phone(Required)

Personal Reference Address(Required)

Street Address Address Line 2 City State ZIP Code

Former Employers(Required)

List all former employers for all household members. Include self-employed earnings. Use the plus (+) button on the right to add more employers.

Name of Working Person

Name & Address of Employer

Gross Earnings Per Year

Type of Work

Supervisor

How Long?

Credit References(Required)

Name

Address

Type

Account #

Please list at least 2 credit references. Type can include Checking, Savings, or Loan. Use the plus (+) button on the right to add more credit references.

Why are you leaving your present residence?(Required)

How far away do you work (in miles)?(Required)

Any litigation, such as evictions, suits, judgments, bankruptcies, foreclosures, etc.?(Required)

Yes

Litigation details(Required)

In case of emergency, please notify:(Required)

Emergency Contact Phone(Required)

Emergency Contact Address(Required)

Street Address Address Line 2 City State ZIP Code

It is understood that the premises are to be used as a residence to be occupied by not more than ______ persons and that occupancy is subject to possession being delivered by present occupant. An application fee in the sum of $_______________ received on ____________________ (date) has been deposited with Landlord, with the clear understanding that this application, including each prospective occupant, is subject to approval and acceptance by Landlord in its sole discretion. I hereby authorize Landlord to obtain information it deems desirable in the processing of my application, including: credit reports, civil or criminal actions, rental history, employment/salary details, police and vehicle records, and any other relevant information; and release Landlord, its employees and agents from all liability for any damage whatsoever incurred in furnishing or obtaining such information. Upon approval and acceptance, the applicant agrees to execute a lease before possession is given and to pay the security deposit and the first month's rent within five days after being notified of acceptance (time being of the essence); failing which the application fee shall be retained by Landlord as the agreed compensation for credit investigation, processing and verification of the application, other expenses and/or loss of rent, and the Landlord shall have no further obligation to applicant. In no event is the application fee refundable to the applicant, except in the event that Landlord fails to deliver possession of the premises as may be required by any lease executed between the parties. The applicant hereby waives any claim for damages by reason of non-acceptance of this application which the Landlord or his agent may reject without stating reasons for so doing. It is further agreed that if any information herein is false, the lease made on the strength of this application may, at the option of the Landlord, be terminated at any time.

CAMBA Housing Ventures

Application

Shinda Management Corporation

1. This information is to be filled out by the applicant

2. Family Composition

3. Project Based or Tenant Based Subsidy

4. Income

5. Other Sources of Income

6. Current Assets

7. Assets Recently Disposed Of

8. Medical Expenses

9. Handicap Expenses

10. Child Care Expenses

11. Persons with Disabilities

12. Authorization of Background Check

13. Drug, Criminal and Sex Offender Background Information

14. Program Information

15. Racial Group Identification

16. Additional Information

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