PRE- APPLICATION INSTRUCTIONS

1 PRE- APPLICATION INSTRUCTIONS . To apply for the waiting list(s) with GJHA. Please READ prior to completing your APPLICATION . Thank you. 1. Head of Household (HOH Required) 9. Veteran (optional) Serves families in a townhouse style with 2-3. Mailing and Residence Information. We require For statistical purpose only. bedroom units. Only twelve (12) Voucher applicants to identify a single Head of Household 10. Family Members (Required) Based Units available. The units offer private for each APPLICATION . We must have the current List everyone who will be living with you at storage, private playground with picnic benches mailing address to contact you at all times. If the time you will receive your housing and grills for use by tenants. All appliances, we are unable to contact you by mail, you will be assistance, including any unborn children. Do W/D hookups are included in the unit.

2 W/S/T. removed from all waiting list(s). not include yourself in the list. If you have more paid by owner. Rent is approximately 30% of 2. Personal Information (HOH Required) people than the lines listed, please list on a household's adjusted monthly income. The HOH's social security number will be used to separate piece of paper. identify your family. 11. Income (Required) Ratekin Tower Apartments 3. Telephone Number (HOH Required) List all income coming into your household. It is Serves elderly and disabled only. One bedroom We need this number in case we have any important to list your annual income and the units, 11 accessible units, all appliances, questions about your APPLICATION . We will not number of hours that you are working. We also laundry facility, commons area, library, tenant use it to contact you for an eligibility must determine if you are eligible for the program association, computer lab, Senior Companion, appointment.

3 You will be contacted by mail. by calculating your gross income for the year. Grey Gourmet Meal Services on premises. 4. Gender (HOH optional) 12. Assets (Required) Mesability transit and the Grand Valley Transit Indicate the sex of the Head of Household. Please describe type of asset and the approximate stop at main entrance. Pet policy/deposit applies. All utilities paid. Rent is approximately 5. Ethnicity (HOH optional) value of the asset. 30% of household's adjusted monthly income. GJHA collects statistical information in 13. Student Status (Required). accordance with federal regulations. People of If you are a student please indicate if you are a various races may also be of Hispanic ethnicity. full-time or part-time student. This information Walnut Park Apartments Please indicate if you are Hispanic. will provide you with the correct preference points Serves elderly and disabled.

4 One bedroom 6. Race (HOH optional) on the waiting list. units, 12 accessible units with a laundry facility For statistical purpose only. The choices listed on site. Also available is a library and gazebo for use by tenants. Pet policy and deposit are the same as the federal government's 14. PROGRAM SELECTION (Required). categories. applies. All utilities paid. Rent is approximately 30% of household's adjusted monthly income. 7. Disability or Handicap (Required) Housing Choice Voucher Program Please tell us if you need any disability related (Section 8) Serves families, singles, elderly accommodations to apply or lease a unit. It is and disabled. Participants will be issued a Nellie Bechtel Apartments not necessary to give us details about your Voucher that allows them to find housing of their Serves elderly (62+ years of age). One and disability. By completing this portion it will allow choice (within a rent limit determined by the two bedroom units, accessible units with a us to give you the correct preference on the laundry facility in each building.)

5 Also available family size.) Units determined by the family waiting list(s). Please tell us if you need any is a library and clubhouse for use by tenants. size.) Units selected must meet HUD. Pet policy and deposit applies. All utilities paid. disability related accommodations to apply regulations for safe and sanitary housing. Rent or lease a unit. is approximately 30% of household's adjusted 15. Certification (Required). 8. Interpreter (Required) monthly income. Please read very carefully. By signing you are If you need an interpreter let our office know so agreeing to its terms. You must sign the form we can accommodate you. Capital Terrace Townhomes where indicated to be placed onto the waiting list(s). PRE APPLICATION FOR HOUSING ASSISTANCE Date Stamp (Office Use ONLY) Preference GRAND JUNCTION HOUSING AUTHORITY Points 8 Foresight Circle, Grand Junction, CO 81505 Bedroom Size Telephone 970-245-0388 FAX 970-241-5514.

6 Past 1/3 of all applications are dropped from the waiting list Participant due to unreported changes. You MUST report ALL Check Date household, income and address changes in writing to the Housing Authority. Please print legibly to help ensure information will be accurately entered into our system. 1. Head of Household (HOH) (Required) 2. Personal Information 3. Telephone Number (Required) (Required). Last Name First Name Middle Initial - - Home Social Security Number Work Mailing Address Apt. # City State Zip Where are you P hysically Living? City State Zip - - Other Birth Date (mm/dd/yy). Are you currently homeless? Yes No _____. Are you currently living in subsidized housing? Yes No Age If yes, name of property: _____ (ex. Grand Manor, Racquet Club, etc.). Address of property:_____. Optional: Optional: Optional: 7. Disability (Required) 8. Interpreter 9.

7 Veteran 4. Sex 5. Ethnicity 6. Race Are you or a family member claiming (Required) (Optional). Male Hispanic Native American Asian a disability? Do you need an interpreter? Are you a Veteran? Female Non Pacific Islander Black Yes, who? _____ Yes Yes Hispanic Alaskan Native (You will be required to provide (What type_____) No verification at eligibility appointment) No White Other _____. No 10. List ALL Family Members Who will be residing with you (Required). Last Name First Name Relation to HOH Sex Social Security Number Date of Birth Age 11. (a) Income of ALL household Members: 11. (b) List Total Income: (Required) 12. Assets (Required) Include bank accounts, (Required) Do not include employment income of children under 18. investments, and real estate. No Adult Family member is employed at this time Adult #1 Type Cash Value $. Adult #1 Hourly wage $_____ $.

8 Unemployment Income Veterans Benefits Paid by the week $_____ $. SSA/SSI/SSDI/SS Survivor (circle one) Child Support Paid by the month $_____ $. TANF/AND/OAP (circle one) Self Employed Involved in a work program (Colo. Works, Voc. Rehab ) 11. (c) Hours Worked (Required) $. Wages/Employer - Name and Location of employer: 13. Student Status (Required). Adult #1. _____ Is the HOH or Spouse a student? Name of Family Member receiving income or involved in a work program #_____ Hours per week _____. Employer's name and Location (Example: Grand Junction, Palisade, Fruita, etc.) Yes No If yes, Adult #2 11. (b) List Total Income: (Required). Unemployment Income Veterans Benefits Name of School : SSA/SSI/SSDI/SS Survivor (circle one) Child Support Adult #2. _____. TANF/AND/OAP (circle one) Self Employed Hourly wage $_____. Location of School: Involved in a work program (Colo.)

9 Works, Voc. Rehab ) Paid by the week $_____. _____. Wages/Employer - Name and Location of employer: Paid by the month $_____. Full Time _____ 11. (c) Hours Worked (Required). Name of Family Member receiving income or involved in a work program Part Time _____ Adult #2 # of Hours_____. Employer's name and Location (Example: Grand Junction, Palisade, Fruita, etc.) # _____ Hours per week 14. Program Selection (Required). P lease check only program s that you are interested in receiving 15. Certification of Applicant assistance and qualify for. See description of programs on instruction page. I hereby certify that the information I have provided in this pre- APPLICATION is true and accurate. I am aware that Federal Law provides for a fine and/or imprisonment for any person who fraudulently receives assistance to Housing Choice Voucher (Section 8) Serves which he/she is not entitled.

10 I understand that any misrepresentation or false information will result in my Elderly/Disabled, Singles and Families APPLICATION being cancelled or denied, or in termination of housing assistance. I understand that at the time of my eligibility interview, I will be required to provide verification of the information I have provided on this pre- Section 8 Domestic Violence Serves Victims of APPLICATION , in accordance with Federal Housing Regulations and GJHA policy. I accept full responsibility for Domestic Violence. Verification required. keeping GJHA informed of my current address and I understand that my APPLICATION will be removed Subsidized Properties from all waiting lists if I fail to do so. I understand that the GJHA will contact me by mail and if I do not respond in the required time frame, or my mail is returned to the GJHA, I will be removed from all Ratekin Tower Serves Elderly/Disabled waiting lists.