Microsoft Word - VETV - TC Application 2022.05

VETERANS VILLAGE OF GLENDALE

331 Salem St., Glendale, CA 91203

Phone: (818) 956-7970 TTY: (800) 855-7100

APPLICATION INSTRUCTIONS

Dear Applicant:

Thank you for your interest in Veterans Village of Glendale, a 44-unit tax credit community, located in

Glendale, California. This property has a preference provided to U.S. Veterans and their families.

The general waiting list is open.

This packet provides important information about the property and how to apply. Please read this

information carefully.

Please complete the attached application in its entirety. Please do not submit copies of SS cards,

personal ID, licenses, or any financial or personal documents at this time. Upon request, application

materials will be made available in a format that meets the needs of an applicant with disabilities.

Be sure to check your application for accuracy. You will not be able to change your application

information (except for contact information) after the application is submitted. If your contact

information changes (e.g., address, phone number, email, etc.), please notify us by mailing the

updated information to the above address using your name as it appears on your previously

submitted application.

Completing the Application

 Use BLACK INK to complete the application.

 Complete all the information – no blanks. Incomplete applications will be returned for additional

information.

 Do not use white out. White out corrections are not accepted. To make corrections, make one

(1) line through any mistakes and initial any changes.

If you pick up or download an application, please fill out the application and then submit your

completed application in person, by mail, or by email to:

In Person

or By Mail:

Veterans Village of Glendale

331 Salem St., # Manager’s Office

Glendale, CA 91203

Email: vv

g

lendale

@

tsaproperties.com

Applications that meet the preliminary screening requirements will be entered into our waiting list.

Applications will be processed on a first come first served basis and in the order they are received.

We hope that you will have the opportunity to make Veterans Village of Glendale your home. If you

have any questions or concerns, please contact the management office at (818) 956-7970.

Sincerely,

Veterans Village of Glendale Management

Rental Application

Veterans Village of Glendale

331 Salem St., Glendale, CA 91203

Phone: (818) 956-7970 TTY: (800) 855-7100

Email: [email protected]

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INSTRUCTIONS

Please complete ALL sections of this application. Please do not leave any questions blank or use White Out. ALL adult

household members (18 and over) must sign the application. Screening criteria available upon request. Please do not

submit multiple applications.

OCCUPANCY LIMITS

To qualify for each of the unit sizes, please note the minimum and maximum persons required. See the Tenant Selection

Plan for additional information regarding occupancy guidelines. Please check the bedroom size requested.

Non-Age Restricted

Minimum Maximum

☐ 1 Bedroom

1 person 3 people

☐ 2 Bedroom

3 people 5 people

☐ 3 Bedroom

4 people 7 people

HOUSEHOLD INFORMATION

List ALL household members that are applying to live in the apartment beginning with the Head of Household (HOH).

Include any household member that is under the age of 18 and will reside in the household 50% of the time or more. Be

sure to include your own name. Failure to provide accurate and complete contact information may result in application

denial.

Last Name First Name MI

Relationship

to HOH

Optional

M/F SSN

Birthdate

MM/DD/YYYY

1. Self

2.

3.

4.

5.

6.

7.

CURRENT CONTACT INFORMATION (Required)

What is your preferred method of being contacted? ☐ Mail ☐ E-Mail ☐ Other_______________

Current Address:

Mobile phone: Other Phone:

Email Address: Other Contact:

REASONABLE ACCOMMODATION INFORMATION

Veterans Village of Glendale has accessible units and/or units with accessible features. Applicants may inquire about

features of these units by contacting the management office (818) 956-7970 or TTY (800) 855-7100.

1. Do you require that your apartment be designed for the disabled/mobility impaired?

☐ Yes ☐ No

‐ Please check if applies:

☐ Mobility ☐ Vision ☐ Hearing

‐ Please explain the required modification needed:

A person with a disability may ask for:

 A change in rules (reasonable accommodation)

 A physical change to their apartment or shared areas in the building (reasonable modification)

 An accessible apartment

 Aids and services to help them communicate with us

Rental Application

Veterans Village of Glendale

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If you or anyone in your household has a disability and needs any of these things to live at Veterans Village of Glendale and

use our services, please contact the management staff to fill out a ‘Reasonable Accommodation or Modification Form.’

EFFECTIVE COMMUNICATION

Please notify the management office if you need application assistance such as large type font, information by audio tape,

computer disk, Braille and/or a language other than English. Best efforts will be made to accommodate such requests.

Primary

Language:

☐

(Arabic) ﻰﺑﺭﻋ

☐

(Cantonese)

广东话

☐

(Mandarin)

普通话

☐

(Russian) русский

☐

(Spanish) Español

☐

(Tagalog) Tagalog

☐

(Vietnamese) Tiếng Việt

☐

(Korean)

한국어

☐

Other: __________________

OTHER HOUSEHOLD INFORMATION

1. How did you hear about this property?

☐ Banner

☐ C.E.S.

☐ Comm. Center

☐ Flyer

☐ Friend/Family

☐ Internet/Online

☐ LAHD Registry

☐ Newspaper

☐ TSAHousing.com

☐ Walk-By

☐ Other _____________

2. Is any member of your household disabled according to the Fair Housing Act definition for handicap (disability):

a. A physical or mental impairment which substantially limits one or more major life activities; a record of such an

impairment or being regarding as having such an impairment. For a definition of “physical or mental impairment

and other terms, please see 24 CFR 100.201

b. Handicap does not include current, illegal use of or addiction to a controlled substance.

c. An individual shall not be considered to have a handicap solely because that individual is a transgender.

☐ Yes ☐ No ☐ Do not wish to disclose

3. ☐ Please check here if you have been displaced by governmental action or if your dwelling has been destroyed as a

result of a disaster formally recognized pursuant to federal disaster relief laws. (Third-party verification will be required).

4. ☐ Please check here if you are a Veteran of the United States Armed Forces. (DD214 or equivalent will be required).

5. Veterans Village of Glendale is a non-smoking and no pet* property. Each applicant 18+ must initial below to

acknowledge that you understand smoking will not be permitted throughout the property up to the property line and that

no pets are permitted. *Assistance animals are not considered pets.

Initials HOH Initials Initials Initials Initials Initials Initials

6. List any Case Worker or Agency that you are working with, that you would like us to be aware of or contact.

Agency Name: Case Worker Name:

Agency/Case Worker Phone: Email:

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Veterans Village of Glendale

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We are required to adhere to Federal Fair Housing laws and to encourage a balanced resident population at Veterans

Village of Glendale. This housing is offered without regard to race, color, religion, sex, gender, gender identity and

expression, family status, national origin, marital status, ancestry, age, sexual orientation, disability, source of income,

genetic information, arbitrary characteristics, or any other basis prohibited by law. As such, we appreciate your checking the

appropriate boxes below regarding your race/ethnicity. You are not obligated to provide this information. If you choose not

to disclose, please indicate below.

CURRENT RESIDENCE

1. What is your current monthly rent? $ /month

2. Why do you intend to vacate your current residence?

3. What is the size of your current residence? # of Bedrooms

(Please indicate “0” for a studio or bachelor unit)

Yes No

4. Do you expect any additions to the household within the next 12 months?

☐ ☐

Name & Relationship:

Explanation:

5. Is there anyone living with you now who would not be living with you at this property?

☐ ☐

Name & Relationship:

Explanation:

6. Are there any absent household members who under normal conditions would live with you?

☐ ☐

Explanation:

7. Are you currently separated or estranged from your spouse?

☐ ☐

8. Do you or any household members own a car?

☐ ☐

If yes, how many cars? Number of cars:

Ethnic Categories

☐

Hispanic

☐

Not Hispanic

☐

Non-Disclosed

Racial Categories

☐

Black/African American

☐

Asian

☐

Native Hawaiian/Other Pacific Islander

☐

White/Caucasian

☐

Asian Indian

☐

Native Hawaiian

☐

American Indian/Alaska Native

☐

Chinese

☐

Guamanian or Chamorro

☐

Other

☐

Filipino

☐

Samoan

☐

Non-Disclosed

☐

Vietnamese

☐

Other Pacific Islander

☐

Japanese

☐

Korean

☐

Other Asian

Rental Application

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HOUSEHOLD BACKGROUND INFORMATION

Yes No

1. Have you, or anyone else named on this application, filed for bankruptcy?

☐ ☐

Explanation:

2. Have you, or anyone else named on this application, been convicted of a felony within the last 7 years?

☐ ☐

Explanation:

3. Have you or anyone else named on this application

been evicted from a rental unit of any type

including an apartment, home, mobile home or trailer?

☐ ☐

Explanation:

4. Have you or anyone else named on this application been convicted of drug/paraphernalia use,

possession, or distribution?

☐ ☐

Explanation:

RENTAL HISTORY AND HOUSING REFERENCES

Please list all locations you have lived in the last FIVE (5) years starting with CURRENT address. If additional space is

required, use the back of this page.

Landlord’s Name/Address Your Address Own/Rent Dates

(1) Name: Own

☐

From:

Address: Rent

☐

To:

Homeless

☐

Phone:

(2) Name: Own

☐

From:

Address: Rent

☐

To:

Homeless

☐

Phone:

APPLICANT STATUS

Yes No

1. Will you or any ADULT household member require a live-in aide? (Third-party verification will be

required).

☐ ☐

Name of Attendant:

Relationship (if any):

2. Do you currently, at the time of application, receive Section 8 rental assistance?

☐ ☐

Name of Agency:

Contact Person:

3. Do you currently have or are you expecting a Section 8, Choice Voucher, V.A.S.H., or other Voucher?

☐ ☐

Expected Date:

Name of Agency:

Contact Person:

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FULL-TIME STUDENT INFORMATION

This apartment is governed by Federal and/or State Housing Program(s) that restrict full-time students. We must

determine your household student status prior to eligibility and, if such eligibility is granted, each subsequent year you

remain in the unit. If unsure of Full-Time status, inquire with academic institution for determination of “Full-Time”

prior to completing the following section.

Yes No

1. Are you or any member of your household above (including minors) currently a Part-Time Student?

☐ ☐

2. Are you or any member of your household above (including minors) currently a Full-Time Student?

☐ ☐

3. Does the entire household consist of people who are currently full-time students?

☐ ☐

4. Does the entire household consist of people who are either currently a full-time student or were a full-

time student for 5 months or more in the current calendar year?

☐ ☐

5. Do you or any member of your household above (including minors) anticipate becoming a Full-Time

Student?

☐ ☐

If Yes to any of the previous questions, complete the following:

Yes No

6. Is anyone in your household receiving assistance under Title IV of the Social Security Act (AFDC,

TANF, CalWorks – not SSA/SSI)?

☐ ☐

7. Is anyone in your household enrolled in a job training program receiving assistance under the Job

Training Partnership Act (JTPA), Workforce Investment Act (WIA), or other similar federal, state, or

county government program?

☐ ☐

8. Is anyone in your household married and filing (or are entitled to file) a joint tax return? (please provide

a copy of marriage certificate or tax return)

☐ ☐

9. Is anyone in your household a single parent with a dependent child(ren) and neither of you or your

child(ren) are dependents of another individual?

☐ ☐

10. Is anyone in your household under the age of 24, who has exited the Foster Care System (currently

age 18-24)?

☐ ☐

INCOME INFORMATION

Income is counted for anyone 18 or older (unless legally emancipated). However, if the income is unearned income such

as a grant or benefit, it is counted for all household members including minors. Answer the questions in this section to

provide the source(s) of all household income. Include all income anticipated for the next 12 months.

(Use the back of this form if you need more space.)

Do YOU or ANYONE in your household receive OR expect to receive income from:

YES NO

1. Employment wages, or salaries, or self-employment? (Include overtime, tips, bonuses,

commissions, and payments received in cash. Use an additional page to add additional employment

income sources.)

☐ ☐

Household Member

__________________________

Name of Company

__________________________

Amount / Month

$_________________________

2. Social Security, SSI or any other payments from the Social Security Administration?

☐ ☐

Household Member

__________________________

SSA / SSI / SSDI?

__________________________

Amount / Month

$_________________________

3. Pension, retirement benefit or annuities?

☐ ☐

Household Member

__________________________

Type of Pension / Annuity

__________________________

Amount / Month

$_________________________

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4. Regular gifts or payments from anyone outside of the household? (This includes anyone

supplementing your income or paying any of your bills, utilities, groceries, or other expenses.)

☐ ☐

Household Member

__________________________

Name of Person

Supplementing Income

__________________________

Amount / Month

$_________________________

5. Any other income sources or types not listed? (e.g., alimony or child support (whether or not it is

received), pay as a current member of the Armed Forces, unemployment benefits or workers’

compensation, public assistance or general relief, payments from a severance package, payments

from any type of settlement, payments from rental property or other types of real estate transactions,

payments from lottery winnings or inheritances, etc.)

☐ ☐

Household Member

__________________________

Type of Other Income

__________________________

Amount / Month

$_________________________

6. Do you, or any other household member, expect any changes to your income in the next 12

months?

☐ ☐

Household Member

__________________________

Explanation

__________________________

Amount / Month (if applicable)

$_________________________

7. As needed, please provide notes on any other income here:

ASSET INFORMATION

Include all assets held and the income derived from the asset. INCLUDE ALL ASSETS HELD BY ALL HOUSEHOLD

MEMBERS INCLUDING MINORS. Answer the questions in this section to provide the source(s) of all household assets.

(Use the back of this form if you need more space.)

Do YOU or ANYONE in your household have:

YES NO

1. Checking, Savings, Direct Express Cards, CDs, Money Markets, and/or Treasury Bills?

☐ ☐

Household Member

______________________

Account Type

______________________

Institution

______________________

Last 4 of Account

______________________

2. Cash on hand? This is cash not kept in a bank account

☐ ☐

Household Member

______________________

Cash on Hand

$_____________________

3. Real estate, rental property, land contracts/contract for deeds or other real estate holdings?

(This includes your personal residence, mobile homes, vacant land, farms, vacation homes or

commercial property.)

☐ ☐

Household Member

__________________________

Type

__________________________

Value

$_________________________

4. Funds held in a payment service account, such as Venmo, PayPal, CashApp, Skrill, etc.?

☐ ☐

Household Member

__________________________

Source

__________________________

Value

$_________________________

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5. Crypto Currency such as Bitcoin, Litecoin, Ethereum, etc.?

☐ ☐

Household Member

__________________________

Type

__________________________

Value

$_________________________

6. All other asset sources or types not listed? Include name of institution where the asset is held, type

of asset, value of asset, and any interest or income from the asset.(i.e. Paintings, coin or stamp

collections, artwork, show cars, antiques, Stocks, bonds or securities, trust funds, pensions, IRAs,

Keogh or other retirement accounts, whole life insurance, contents of a safe deposit box, etc.)

☐ ☐

Household Member

__________________________

Type

__________________________

Value

$_________________________

7. Have you disposed of an asset in the last two years? (Ex.: Cash over $1000, a home, other real

estate, etc.)

☐ ☐

Household Member

__________________________

Type of Other Income

__________________________

Amount / Month

$_________________________

8. As needed, please provide notes on any other assets here:

COMMUNITY INTEREST

1. Drug and Crime Free Acknowledgement: Your initials below will acknowledge that you understand that this

apartment community will vigorously enforce a drug and crime free environment. You and your guests agree not to

engage in any drug-related activity, including the manufacture, sale, distribution, use, or possession of illegal drugs.

These activities are a material violation of the lease and good cause for termination of tenancy. Each adult household

member 18+ initials below.

Initials HOH Initials Initials Initials Initials Initials Initials

2. OPTIONAL: We are providing extensive recreation facilities and activities at this property for the enjoyment of our

residents. Since we are always looking for assistance to coordinate special programs and activities, we would

appreciate a brief description of your skills, interests, hobbies and any assistance/leadership you might provide to these

programs.

SIGNATURE CLAUSE



Upon notification by landlord of application processing, I agree to pay Veterans Village of Glendale an application screening

charge in the amount required by landlord. I will be issued a Receipt for Application Fee upon payment which will authorize

Veterans Village of Glendale to obtain any such credit reports, character reports and/or criminal reports, and verification of

rental and employment history as it deems necessary to verify all information set forth in this application. I understand that I

will acquire no rights to the above property until I sign a rental agreement and submit a security deposit. I further

understand that false, fraudulent misleading or incomplete information may be grounds for denial of tenancy or subsequent

eviction. There are no other agreements express or implied between the parties.

I understand that management is relying on this information to prove my household’s eligibility for housing at Veterans

Village of Glendale. I certify that all information and answers to the above questions are true and complete to the best of my

knowledge. I understand that providing false or misleading information or making false statements may be grounds for

denial of my application. I also understand that such action may result in criminal penalties.

Rental Application

Veterans Village of Glendale

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I authorize and consent to have management verify the information contained in this application for purposes of proving my

eligibility for occupancy. I will provide all necessary information including source names, addresses, phone numbers, and

account numbers where applicable and any other information required for expediting this process. I understand that my

occupancy is contingent on meeting management’s resident selection criteria and any low-income housing program

requirements.

In accordance with state and federal laws, I have been notified that an investigation may be made of the information I

provided on this application together with information as to my character, general reputation, personal characteristics, and

mode of living. I understand that I have the right to dispute the accuracy of information obtained from the entities I have

disclosed above, and, upon written request, the right to a complete and accurate disclosure of any scope of this

investigation and/or a written summary of my rights under the Fair Credit Reporting Act.

All adult household members must sign below:



 

Head of Household Signature Date Other Adult Signature Date

Other Adult Signature Date Other Adult Signature Date

Other Adult Signature Date

CREDIT INFORMATION

Notice Regarding California Investigative Consumer Reporting Agencies Act:

☐ Landlord does not intend to request an investigative consumer report regarding the Applicant.

Unless the box above is checked, pursuant to California Civil Code section 1786.16(a)(3), the Landlord intends to request

an investigative consumer report in connection with the Applicant’s application for housing. The investigative consumer

report will be made concerning the Applicant’s character, general reputation, personal characteristics, and mode of living.

Among other things, the investigative consumer report may contain information concerning the Applicant’s creditworthiness,

any court judgments against the Applicant, and any criminal charges and/or convictions. Pursuant to California Civil Code

section 1786.22, any files maintained on the Applicant by the investigative consumer reporting agency from which Landlord

obtains the report shall be made available to you during normal business hours and upon reasonable notice, provided you

furnish proper identification, as follows: (1) The Applicant may appear in person at the investigative consumer reporting

agency below to request a copy of the Applicant’s file; (2) the Applicant may make a written request for copies of the

Applicant’s files to be sent via certified mail to a designated addressee; or (3) the Applicant may make a written request for

a summary of the file to be provided over the telephone. “Proper identification” includes documents such as a valid driver’s

license, social security account number, military identification card, and credit cards. If one of these forms of identification

cannot be provided, the agency may ask for other forms of identification in accordance with California Civil Code section

1786.22(c). The investigative consumer reporting agency may charge a fee, not to exceed the actual copying costs, if the

Applicant requests a copy of the Applicant’s file. The agency is required to have personnel available to explain the

Applicant’s file to the Applicant, and the agency must explain to the Applicant any coded information appearing in the file. If

the Applicant chooses to appear in person, the Applicant may choose to bring another person of his/her choice with him/her,

provided that the accompanying person also bring proper identification with him/her. If the Applicant brings another person

with him/her, the agency may require the Applicant to sign an authorization allowing the agency to discuss the Applicant’s

file in the presence of that other person.

Rental Application

Veterans Village of Glendale

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The agency that will prepare the investigative consumer report on the Applicant is:

RentGrow 177 Huntington Avenue, Suite 1703 #74213, Boston, MA 02115

Name of Agency Address of Agency

If you would like a copy of the report(s) that is/are prepared, please check the box below:

☐ I would like to receive a copy of the report(s) that is/are prepared.

Landlord agrees that Landlord, or Landlord’s agent, will send the Applicant a copy of the report within three (3) business

days of the date the report is provided to Landlord. The copy of the report will contain the name, address, and telephone

number of the agency that issued the report and how to contact the agency.

If Landlord takes adverse action against Applicant, and the adverse action is based in whole or in part on the contents of the

investigative consumer report, then, pursuant to California Civil Code section 1786.40(a), Landlord shall so advise Applicant

and shall supply Applicant with the name and address of the agency that prepared the report on which Landlord’s decision

was based in whole or in part.

PLEASE SIGN BELOW TO AUTHORIZE A CREDIT REPORT, EVICTION REPORT, AND CRIMINAL BACKGROUND

CHECK. Management will perform a credit and eviction history and may perform a criminal background check of all

applicants as a part of the applicant screening criteria. Your application will not be considered unless you provide

management with your consent to obtain a credit, eviction, and criminal background report on each adult household

member.

All adult household members must sign below:

Head of Household Signature Date Other Adult Signature Date

Other Adult Signature Date Other Adult Signature Date

Other Adult Signature Date

PLEASE MAIL COMPLETED APPLICATIONS TO:

Veterans Village of Glendale

331 Salem St., #Manager’s Office

Glendale, CA 91203

For Management Use

Date & Time received by Management: ____________________________ Received by: __________________________

WARNING: “Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly

making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any

employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper use of information

collected based on the consent form. Use of the information collected based on this verification form is restricted to the

purposes cited above. Any person who knowingly or willingly requests, obtains or discloses any information under false

pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any

applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other

relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized

disclosure or improper use. Penalty provisions for misusing the social security number are contained in the **Social Security

Act at 208 (a) (6), (7) and (8). Violation of these provisions are cited as violations of 42 U.S.C. 408 (a) (6), (7) and (8).**

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