THIS APPLICATION MUST BE FILLED OUT COMPLETELY. ALL AREAS THAT REQUIRE A SIGNATURE, MUST BE SIGNED AND DATED.

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1 BROOKSIDE TERRACE APARTMENTS 33 MILL STREET NEWTON, NEW JERSEY OFFICE FAX: KAREAMEH ABDELJABBAR SITE MANAGER HELEN ROBINSON ASSISTANT MANAGER THIS APPLICATION MUST BE FILLED OUT COMPLETELY. ALL AREAS THAT REQUIRE A SIGNATURE, MUST BE SIGNED AND DATED. ANY APPLICATION THAT IS INCOMPLETE, WILL NOT BE PLACED ON THE WAITING LIST, IT WILL BE RETURNED TO THE HEAD OF HOUSEHOLD. PLEASE PRINT CLEARLY. IF YOUR PHONE NUMBER OR ADDRESS CHANGE BEFORE YOUR NAME IS CALLED, CALL , MONDAY FRIDAY BETWEEN 8:30 A.M. TO 4:30 P.M.,TO UPDATE YOUR INFORMATION THANK YOU, MANAGEMENT OFFICE Page 1 of 16

2 BROOKSIDE TERRACE APARTMENT APPLICATION PRINT ALL INFORMATION DATE PROJECT: Brookside Terrace 33 Mill Street Newton, New Jersey A. APPLICANT Tel: Fax: NAME ADDRESS APT. CITY, STATE, ZIP CODE HOME PHONE # WORK PHONE # CURRENT RENT $ DO YOU PAY THE UTILITIES? HOW MUCH PER MONTH AVERAGE $ (EXCLUDE PHONE) LIST THE NAMES, ADDRESSES AND PHONE NUMBERS OF RELATIVES OR FRIEND WHO GENERALLY KNOW HOW TO REACH YOU. 1. NAME ADDRESS: PHONE #: 2. NAME ADDRESS: PHONE # B. HOUSING STATUS HOW MANY PEOPLE RESIDE IN YOUR HOME? HOW MANY BEDROOMS IN YOUR HOME? WHY DO YOU WISH TO MOVE? ARE YOU BEING EVICTED? (Yes or No) WHEN MUST YOU BE OUT OF YOUR HOME? HAVE EVER BEEN EVICTED AND IF SO FROM WHERE AND WHEN? ARE YOU NOW IN A GOVERNMENT SUBSIDIZED RENTAL UNIT? HAVE YOU EVER APPLIED FOR A GOVERNMENT SUBSIDIZED UNIT BEFORE? IF SO, WHERE HOW LONG HAVE YOU RESIDED AT YOUR CURRENT RESIDENCE? PRESENT LANDLORD S NAME AND ADDRESS PHONE # FORMER LANDLORD S NAME AND ADDRESS PHONE # C. FAMILY OR HOUSEHOLD COMPOSITION LIST HEAD OF HOUSEHOLD, ALL OTHER HOUSE MEMBERS AND THEIR RELATIONSHIP TO THE HEAD. ONLY LIST PEOPLE MOVING TO BROOKSIDE UNIT. MEMBER'S FULL NAME RELATIONSHIP BIRTH DATE AGE SOCIAL SECURITY Head Page 2 of 16

3 Do you have a SECTION 8 Voucher,(circle one)---yes or No. Do you have TRA (Temporary Rental Assistance?) (Circle one) Yes or No Are you on the waiting list for Section 8 (circle one)---yes or No. D. CHECK ONE (1) OF THE FOLLOWING: White (Non-Hispanic) Black (Non-Hispanic) Asian or Pacific Islander American Indian Hispanic Other E. SOURCE OF INCOME LIST ALL INCOME SOURCES. THIS INCLUDES, BUT IS NOT LIMITED TO, FULL AND/ PART-TIME EMPLOYMENT, ALL INCOME FROM WELFARE AGENCIES, SOCIAL SECURITY, PENSION, SSI, DISABILITY, ARMED FORCES RESERVES, UNEMPLOYMENT COMPENSATION, CHILD CARE, ALIMONY, CHILD SUPPORT, SCHOLARSHIPS AND GRANTS, CONTRACT FOR DEED, INTEREST ON ASSETS, DIVIDENDS, ANNUITIES, REGULAR CONTRIBUTIONS FROM PEOPLE NOT RESIDING WITH YOU. MEMBER EMPLOYEE, AGENCY, BANK, ETC. WHO ARE SOURCES OF ANNUAL GROSS NUMBER INCOME TO YOU. LIST NAME AND ADDRESS OF SOURCES. INCOME TO YOU F. SOURCE OF INCOME DO YOU OWN A CAR? YES NO MAKE MODEL YEAR AUTOMOBILE LICENSE NUMBER DRIVERS LICENSE NUMBER CHECKING ACCOUNT # BANK NAME CITY BALANCE SAVINGS ACCOUNT # BANK NAME CITY BALANCE DO YOU OWN ANY TYPES OF BONDS? NOTE FACE VALUE TOTAL $ STOCKS $ IF YOU OWN A HOME LIST THE ANTICIPATED GROSS SALE PRICE $ G. UNUSUAL AND MEDICAL EXPENSES DO YOU PAY FOR CHILD CARE DUE TO EMPLOYMENT? WEEKLY COSTS $ IS CHILD CARE COST COVERED BY AFDC? DO YOU HAVE MEDICARE? DO YOU HAVE OTHER MEDICAL INSURANCE? GIVE THE NAME OF THE INSURANCE COMPANY AND YOUR POLICY # WHAT IS YOUR DISABILITY OR ILLNESS? DOES MEDICAID PAY YOUR DOCTOR AND DRUG BILLS ARE YOU RECEIVING MEDICAL ASSISTANCE THROUGH WELFARE? IF YOU PAY ANY PORTION OF THE MEDICAL/DRUG COSTS, YOU SHOULD SUPPLY US WITH THE BILLS AND THE RECORDS OF WHAT WAS PAID FOR YOU. Page 3 of 16

4 H. DISPLACEMENT STATUS ARE YOU BEING DISPLACED? BY GOVERNMENT ACTION OR PRIVATE ACTION? LIST REASON PROGRAM INFORMATION ARE YOU A VETERAN? YEARS OF SERVICE (DATES) IF YOU ARE HANDICAPPED LIST THE EXTENT OF YOUR DISABILITY I AGREE TO GIVE THE OWNER/AGENT THE AUTHORITY TO CONDUCT A CRIMINAL BACKROUND CHECK, SEX OFFENDER SEARCH, TO INVESTIGATE MY CREDIT RATING AND MY CURRENT AND PAST RENTAL HISTORY. THE INFORMATION OBTAINED WILL BE USED FOR MANAGEMENT PURPOSES ONLY AND WILL BE HELD IN CONFIDENCE. I HEREEBY ACKNOWLEDGE THAT ALL APPLICATION INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE: SIGNATURE DATE NOTE: The following questions pertain to yourself and every member of your household who will occupy the unit during the period in which you will receive Assistance. YES NO A. EMPLOYMENT ( ) ( ) 1. Is any member of your household employed, either full-time, part-time or seasonally? ( ) ( ) 2. Did any member of your household expect to work for any period of time during the coming months? ( ) ( ) 3. Does any member of your household expect to work for any period of time during the coming months? ( ) ( ) 4. Is any member of your household on a leave of absence from work due to lay-off or for reasons of medical military, or maternity leave? ( ) ( ) 5. Is any member of your household on probationary status at work? ( ) ( ) 6. Does any member of your household expect to be rehired by their past employer? ( ) ( ) 7. Does any member of your household expect to be terminated from work in the near future? ( ) ( ) 8. Has any member of your household waiting to be called by a prospective employer? ( ) ( ) 9. Is any of your household waiting to be called by a prospective employer? ( ) ( ) 10. Does any member of your household work for a person who pays them in cash? Page 4 of 16

5 YES NO B. UNEMPLOYMENT BENEFITS ( ) ( ) 1. Is any member of your household receiving or expecting to receive unemployment benefits? C. BENEFITS ( ) ( ) 1. Does any member of your household receive or expect to receive child support? ( ) ( ) 2. Has any member of your household ever applied for child support? ( ) ( ) 3. Has any member of your family pay you money on a regular basis? ( ) ( ) 4. Does any member of your household receive or expect to receive welfare? ( ) ( ) 5. Has any member of your household ever applied for welfare? ( ) ( ) 6. Is any member of your household receiving or expecting to receive Social Security? ( ) ( ) 7. Has any member of your household applied for Social Security? ( ) ( ) 8. Does any member of your family receive any additional money? ( ) ( ) 9. Is any member of your household receiving financial aid or work-study? D. OTHER ( ) ( ) 1. Is anyone in your household a member of the Armed Forces or Reserves? ( ) ( ) 2. Is any member of your household in the process of enlisting? ( ) ( ) 3. Is there anyone not listed on your application living in your unit or spending any time at your unit? ( ) ( ) 4. Do you expect any one to do so in the future? APPLICANT SIGNATURE DATE Page 5 of 16

6 To Applicant: Please note that periodically the Rental Office will be sending letters to update the waiting list. YOU MUST RESPOND IN WRITING TO THE MANAGEMENT OFFICE INDICATING WHETHER OR NOT YOU WANT TO REMAIN ON THE WAITING LIST. IF WE DO NOT HEAR FROM YOU IN THE TIME SPECIFIED, YOUR APPLICATION WILL BE REMOVED FROM THE WAITING LIST. Also, at any time there is a change of address or phone number, it is your responsibility to notify our office. If we are unable to contact you because of an incorrect address or phone number, your application will be removed from the waiting list. I. INVOLUNTARLY DISPLACED(or expected to be displaced within six months) A. Reason for Displacement (describe circumstances on the appropriate line) 1. Disaster: 2. Government Action: 3. Action by Owner: 4. Are you or any other member of your household a victim of domestic violence? 5. Other: B. If you are already displaced, what are your current living arrangements? C. If you are not already displaced, when do you expect to be displaced? II. LIVING IN SUBSTANDARD HOUSING A. Building is dilapidated (describe) B. Inoperable plumbing C. Unusable flush toilet D. Unusable bathtub or shower E. No electricity or unsafe service F. No safe or adequate source of heat G. Should, but has no kitchen facilities H. Has been declared unfit for habitation (explain) I. Applicant is homeless (describe current living conditions) Page 6 of 16

7 III. APPLICANT IS PAYING MORE THAN 50% OF INCOME FOR RENT What is your gross monthly income? What is your monthly rent? What are your monthly utility costs paid for directly by you? Rent + Utility Costs divided by Gross Monthly Income equals: Percent The Landlord agrees not to discriminate based upon race, color, religion, creed, national origin, sex, age, familial status, and disability. Brookside Terrace does not discriminate on the basis of handicapped status in the admission or access to, or treatment or employment in, its federally assisted programs and activities. I understand that each eligible applicant with or without a Federal preference must meet the owner s tenant selection criteria before gaining acceptance for tenancy. Signature of Applicant Date Signature of Spouse, Co-head or Occupant Date Ka31710 Page 7 of 16

8 Brookside Terrace 33 Mill Street Newton, NJ Fax I, PRINT NAME HAVE RECEIVED AND READ THE TENANT SELECTION POLICY. KEEP THE TENANT SELECTION POLICY FOR YOUR RECORDS. SIGNATURE DATE THIS PAGE MUST BE RETURNED WITH THE APPLICATION. THANK YOU Page 8 of 16

9 KEEP FOR YOUR RECORDS BROOKSIDE TERRACE TENANT SELECTION POLICY Brookside Terrace has formulated a Tenant Selection Policy, which meets HMFA requirements. This Policy establishes a set plan, which can be consistently applied to all applicants. ELIGIBILITY CRITERIA Prior to being placed on the waiting list and again during processing for occupancy, an applicant must qualify under ALL eligibility criteria. These criteria are as follows: I. Income limits are established and adjusted annually. The household s annual income may not exceed the applicable income limits for this property or for the household size. II. Rent. The applicant must agree to pay the rental amount established. In addition, if an applicant has TRA, DCA or SHE, they must be capable of paying the rent amount established for a minimum of 36 months and notify the management office at least 6 months before your temporary assistance expires so you can be placed on Brookside s list for assistance. Brookside Terrace cannot guarantee you assistance if and when your temporary assistance expires. We can only extend a subsidy to qualified applicants and/ or tenants when we have subsidies available. Third party personal checks will not be accepted. III. Only Residence. The unit must be the household s only residence. Assistance may not be provided to households who maintain another residence in addition to the assisted unit. IV. Household. Only those individuals listed on the lease may reside in the unit. V. Unit size requirements. The applicant must abide by the following unit size requirements: A. No more than two persons will be allowed per bedroom. B. In order to maximize the use of available housing, management will strive for occupancy of two persons per bedroom. Valid exception to this policy: Page 9 of 16

10 1. State or local occupancy laws, which restrict the number of persons. 2. Husband and wife or co-tenants who cannot sleep together for medical reasons of which a doctor s statement is required. 3. A handicapped or elderly adult requiring live-in assistance. However, the final decision is at the discretion of the tenant. 4. Two children of the same sex who cannot occupy the same room for medical reasons; which a doctor s statement is required. 5. Management will encourage parents with children of the opposite Sex to have the children occupy separate bedrooms. However, the final decision is at the discretion of the tenant. 6. Management will encourage adults not to share the same bedroom with a child. However, the final decision is at the discretion of the tenant. 7. Compliance with applicable HUD regulations regarding assignment of a larger unit. VI. Social Security Numbers. The applicant must disclose the Social Security Numbers of all household members. If a household member does not have a Social Security Number, the applicant must sign a certification to that fact. VII. Restrictions on Assistance to Non-Citizens. Assistance can only be provided for applicants and their household members if they are either United States Citizens, Nationals or have eligible immigration status. 1. Applicants and all household members claiming to be a U.S. Citizen or A National must sign a declaration attesting to such status. When the household member is a minor child, the declaration must be signed by the parent or a responsible adult. 2. Applicants and all household members claiming to have eligible Immigration status AND who are 62 years of age or older, must sign a declaration attesting to such status AND provide proof of age. 3. All other applicants and household members claiming to have eligible immigration status must sign a declaration attesting to such status AND provide INS documents supporting said status. When the household member is a minor child; the declaration must be signed by the parent or a responsible adult. ALL information provided in support of eligible immigration status must be independently verified with the INS before eligibility can be determined. Page 10 of 16

11 a) Assistance can only be provided for the household members whose eligible immigration status has been provided. b) Should the household contain eligible and ineligible household members, assistance will be provided in accordance with HUD regulations. An elderly family is defined as a family whose head, spouse or sole member are persons at least 62 years old. ELIGIBILITY OF STUDENT APPLICANTS Students applying to be either head-of household or co-head must meet the following eligibility requirements: * Must have maintained a separate household from parents or guardians for at least a year before applying to the community or Is an orphan or ward of the court and are 18 years old or younger Is a veteran of the U.S. Armed Forces Has a legal dependent other than a spouse; such as a child or elderly parent Is a professional or graduate student Is married Is at least 24 years old or will turn 24 years old this year. * Was not claimed as a dependent on your parents or legal guardians most recent tax returns. VIOLENCE AGAINST WOMEN ACT 2005 An application can t be rejected solely because the applicant is a victim of domestic violence, or has been previously evicted from another assisted site for being a victim, as long as s/he meets all project eligibility requirements. The Violence Against Women Act and the Justice Department Reauthorization Act of 2005 protect tenants and family members who are domestic violence victims, which include dating violence and stalking, from subsidy termination and eviction for acts of violence against them. Page 11 of 16

12 A victim will be required to certify domestic violence incidents and must include the name of the abuser and the abuser s relationship to the victim. Third party verification from a victim service provider, a medical professional or an attorney will be required. These victims will not be evicted based on domestic violence incidents. Domestic violence victims may be evicted for lease violations that are unrelated to domestic violence disturbances. Victims may be evicted if it can be shown that the victim s residency poses an actual and imminent threat to other tenants, or to site staff. A domestic abuser will be evicted and their name removed from the lease. Remaining household members may continue to stay in the unit as long as they are eligible. MARKETING Advertising that applications are being accepted for available units will be in accordance with the Affirmative Fair Housing Marketing Plan when said Plan is required. 1. Application. A) A written application must be completed by all applicants. An applicant may pick up an application at the rental office or request that an application is mailed to them. No application will be issued if the waiting list is closed. B) As completed applications are received in the rental office, they are dated, stamped, numbered consecutively and placed on the waiting list. All applicants are processed to one of the three requirements: applicants are admitted to a unit, applicants are rejected because they do not meet all eligibility criteria; applicants remain on the waiting list until an appropriate sized unit becomes available. NOTE: Being placed on the waiting list does not guarantee occupancy of a unit. The applicant can be subsequently rejected for failing one or more of the tenant screening criteria, and/or the eligibility criteria. Page 12 of 16

13 WAITING LIST Applicants will be placed on the waiting list in chronological order. Applicants placed on the waiting list will be notified, in writing, that they will be contacted when an appropriate sized unit becomes available and approximately how long it will take for a unit to become available. Applicants on the waiting list are required to report, in writing, to the rental office any change of address, telephone numbers or other information that may affect eligibility. If an applicant cannot be reached by the rental office due to unreported changes, the applicant will be removed from the waiting list. Applicants will be offered one unit, appropriately sized to suit the family composition. If the family does not choose to move into the unit, but wishes to remain on the waiting list, their name and application will be placed at the bottom of the waiting list. Brookside Terrace will offer a maximum of three units following this procedure. If, at the third offering, the applicant chooses not to move into Brookside Terrace, their name and application will be removed permanently from the waiting list. TENANT SCREENING AND REJECTION CRITERIA The tenant screening and rejection criteria always applies to all individuals listed as head of household, spouse, co-head of household and members 18 years of age or older, who are expected or proposed to reside in the unit. An applicant household and/or any additional household member who is proposed to reside in the unit, will be refused occupancy for one or more of the following reasons: A) If an applicant fails to meet one or more of the eligibility criteria B) If the applicant submits false information about themselves or any household member. C) If the applicant is unable to produce and/or verify the social security numbers of all household members. If a household member does not have a social security number, the applicant must sign certification to that fact. Page 13 of 16

14 D) Poor credit history. 1) Applicants will sign a release for us to obtain a credit report from a reputable credit reporting agency. 2) Applicants with poor credit history will be rejected. E) Landlord Verification 1) Applicants must demonstrate good rent paying habits with no more than two payments per year being made after a grace period and no legal actions begun for non-payment of rent. 2) For applicants with no prior rental history, evidence of meeting other financial obligations will be considered. 3) A written third party verification will be sent to the current landlord and the previous landlord if the applicant resides less than three years with the current landlord. 4) A Landlord-Tenant court history will be requested on each applicant. F) Home visits will be conducted by the Owner s representative at a prearranged time. All family members who will occupy the unit must be present at this meeting. Recommendations for or against tenancy will be based on an informal visit, but at the same time, our representative will be observing the cleanliness and maintenance of the surroundings (taking into consideration the landlord s responsibilities) and the physical appearance of the applicants and their interaction with family members. Also to be taken into consideration: 1) Habits which could be detrimental to the property or other residentssuch as poor care of appliances, plumbing fixtures, etc. 2) Poor health habits. 3) Evidence of negligent dependant care. Applicants requiring the Assistance of a live in aide must have one. 4) Physical abuse of the facilities. 5) Any evidence of conduct which can be detrimental to the property. NOTE: That poor quality or shabby furnishings are not a basis for rejection. G) Adverse police record, which would be indicated by the following: 1) Any drug or alcohol related arrests. 2) Any arrests for assault and/or battery. 3) Any felony conviction. 4) Any arrests or convictions for public lewdness. 5) Any arrests or convictions for child abuse, endangerment of spousal abuse, stalking or harassment. Page 14 of 16

15 H) Any indication that the applicant cannot adequately sustain decent levels of habitability or control of dependant so as to adversely affect the property or other residents. I) A personal interview that indicates an unstable or potentially hazardous relationship between the applicant household and other residents. J) A personal interview and/or information that indicates the applicant or any household member would be a threat to the safety and well being of the property and/or other residents. K) A personal interview and/or information that indicates the applicant will be unable to comply with the terms of this lease agreement. Each rejected applicant will be promptly notified in writing of the reason(s) for rejection. This notice will advise the applicant that he/she may, within fourteen (14) calendar days of receipt of the notice, request in writing a meeting to discuss the reasons for rejection. Should the applicant request a meeting to discuss the rejection; it would be conducted by a member of the management staff that was not involved in the original decision to reject the applicant. The applicant will be advised in writing of the results of this meeting within five (5) days. Requesting a meeting to discuss the reasons for rejection will in no way prevent the applicant from exercising any legal rights he/she may have. The applicant will be advised of this at the time of rejection. Brookside Terrace will keep the following materials on file for at least three years: Original application Initial rejection notice Any applicant reply Owner s final response All interview and verification information UNIT TRANSFERS The decision to allow unit transfers will be at the sole discretion of the management, based upon changes in family composition and/or possible medical conditions. Families currently living in Brookside Terrace may request a voluntary transfer, at which time their name will be added to an internal waiting list for a particular unit size or type. In order to alleviate rental loss to the Owner, these tenants must agree to pay an additional one-month s basic rent on the apartment currently occupied. These charges must be paid at the time of lease signing for the transfer unit. Page 15 of 16

16 Tenants who must move to a larger or smaller unit because of changes in family composition or possible medical condition, verified by a medical doctor, will be placed on the internal waiting list with no charge to them at their move to a different sized unit. If family size changes, we have the right to transfer the tenant to a larger or smaller unit upon a thirty (30) day notice. Tenants on the internal waiting list will have priority over new applicants. Also, tenants referred to in paragraph 2 above, will be given priority over those requesting a voluntary transfer. NO PET POLICY NO PETS, OF ANY KIND, ARE PERMITTED ON THE PREMISES (INCLUDING VISITING PETS) OR IN THE UNIT. PETS SHALL INCLUDE, BUT NOT BE LIMITED TO, DOGS, CATS, BIRDS, REPTILES, MICE, RODENTS, FERRETS, HAMSTERS OR INSECTS. Page 16 of 16

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