CPAH Rental Pre-Application Please complete all sections as fully as possible. All fields with an asterisk (*) are required. Applicant Name* Address* City* State IllinoisAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code* Telephone Cell Phone Email* D.O.B.* Judgements YesNoN/A Co-Applicant Name Address City State IllinoisAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Telephone Cell Phone Email D.O.B. Judgements YesNoN/A Number of people who will occupy the residence? Are you seeking a certain # of bedrooms or style of housing (house, apartment)? If so, please indicate here. CPAH accepts housing vouchers. Do you have a housing voucher? YesNo Do any dependents in your household reside with you less than full time? YesNo If yes, please explain: Do you currently: RentOwn Payment: How were you referred to CPAH?* 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 If so, where? Employment Are you self-employed? YesNo Employer(s) Address(es) City State IllinoisAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Title Current Gross Monthly Income (BEFORE Taxes) $ Overtime $ Bonuses/Commissions $ Child Support, SSI/SSDI $ Unemployment, etc. $ Other $ TOTAL $ Previous Year's Income $ Co-Applicant Employment Are you self-employed? YesNo Employer(s) Address(es) City State IllinoisAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Title Current Gross Monthly Income (BEFORE Taxes) $ Overtime $ Bonuses/Commissions $ Child Support, SSI/SSDI $ Unemployment, etc. $ Other $ TOTAL $ Previous Year's Income $ Are there additional household members who have income? YesNo If so, please provide employer(s) and employer(s) address for each additional job held by household members. Gross Annual Household Income of Additional Household Members: HOUSEHOLD ASSETS (Please add together) Checking $ Savings $ 401(k), IRA, Pension $ Stocks/Mutual Funds $ Gifts $ Other $ Have you or any member of your household been convicted of a crime in the last 10 years? YesNo If yes, please describe: 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 Date: Additional Comments: I/We authorize Community Partners for Affordable Housing (CPAH) to obtain and/or review my/our credit report(s) to determine our eligibility for CPAH programs. I/We certify that all information contained in this application is true and correct, to the best of my knowledge. I understand that the submission of this information is one of the requirements for tenancy and does not constitute an approval of my application, or my acceptance as a tenant.* Applicant Signature* Co-Applicant Signature
