CPAH Rental Pre-Application

Please complete all sections as fully as possible.

All fields with an asterisk (*) are required.

GENERAL


Judgements
YesNoN/A


Judgements
YesNoN/A

Do any dependents in your household reside with you less than full time?
YesNo

Do you currently:
RentOwn

Please indicate which communities are of interest to you:
Highland ParkLake ForestEvanstonEvanston Sr. Housing (55+)

Do you work in one of these communities?
Highland ParkLake ForestEvanston

APPLICANT EMPLOYMENT & INCOME

Are you self-employed? YesNo




Report Below Numbers as Gross Income (Income BEFORE Taxes)








CO-APPLICANT APPLICANT EMPLOYMENT & INCOME

Are you self-employed? YesNo




Report Below Numbers as Gross Income (Income BEFORE Taxes)








Are there additional household members who have income?
YesNo
If yes, please indicate their name and current gross monthly income.



HOUSEHOLD ASSETS (Please add together and note the assets of all household members)






OTHER FUNDS AND SUPPORTS

CPAH accepts housing vouchers (i.e., Section 8, VASH, etc..). Do you have a housing voucher? YesNo
Are you the owner/beneficiary of an ABLE account? yesno
If yes, what is the current balance? $
Are you the beneficiary of a Special Needs Trust? yesno
If yes, what is the current balance? $
Do you anticipate receiving any one-time or recurring gifts? yesno
If yes, please describe.

BACKGROUND INFORMATION

Have you or any member of your household been convicted of a crime in the last 10 years?
YesNo

Have you or any member of your household been evicted or otherwise involuntarily removed from rental housing due to fraud, non-payment of rent, failure to cooperate with recertification procedures, or for any other reason, in the past 5 years?
YesNo