BLACKLAND HOUSING APPLICATION COVER SHEET

(for office use only)

Name: Date submitted (complete): Complete: Yes No

Phone: Application expires:

Type of House (circle all that apply): 1 BR Need wheelchair accessible (circle)? No. people in household: Log of Conversations Date Content YES

2 BR NO

3 BR

4 BR

Denied:
Reason for denial:

Yes

No

Blackland Affordable Housing Program ~Information Sheet~

The Blackland Affordable Housing Program, a project of the Blackland Community Development Corporation (BCDC), provides affordable housing to low-income families with children under the age of 18 and up to the age of 21 if attending school. Limited affordable housing services are available to individual adults with disabilities. Robert Shaw Village provides affordable housing to senior citizens (62 years old and over with no disability, 60 and over with a disability). The following regulations apply to both programs: Eligibility Requirements You must pass the following eligibility criteria to be accepted into the program: Be at or below 60% of the City of Austins Median Family Income (MFI). The MFI is calculated and updated annually by HUD and is available for review upon request. For certain homes the maximum income is 50% MFI. Have a gross monthly household income of at least 2.5 times the monthly rent; 2 times for Robert Shaw Village Pass a criminal background check (no assaults or criminal sexual behavior) Prove one year of verifiable good rental and employment history Application Process Please speak with Pam Johnson, Blacklands case manager, to determine your eligibility. If you qualify, you will be asked to speak with Donna Henderson, Blacklands property manager, to complete an application and provide the necessary documentation. Applications are processed on a first-come-first-serve basis. The following documents must be provided for your application to be complete and in the queue: Picture I.D. for all household members over the age of 18. Social Security cards for all household members. Birth certificates for all household members. Proof of verifiable income for the past two months Income tax return for the past year Applications are good for six months. After that you will be required to re-apply. APPLYING DOES NOT GUARANTEE YOUR ENTRANCE IN THE PROGRAM, so please continue to pursue other housing options as well.

Blackland Community Development Corporation provides equal and fair housing opportunities. BCDC does not discriminate on the basis of race, religion, sex, disability, national origin, marital or student status, or sexual preference.

BLACKLAND COMMUNITY DEVELOPMENT CORPORATION AFFORDABLE HOUSING PROGRAM RENTAL APPLICATION

Blackland Community Development Corporation provides equal and fair housing opportunities. We do not discriminate against anyone on the basis of race, color, religion, sex, handicap, national origin, marital or student status, age or sexual preference. Any information we request pertaining to ethnicity or race is to ensure compliance with Fair Housing Standards. Providing this information for this application is optional; however, should you be accepted into our housing, you will be required to provide it at that time. Please initial here to show that you have read and understood this: (Each household member other than spouses over 18 years old must submit a separate application)

Name: Present Street Address: City, State, ZIP: Telephone: (home):

Spouses Name:

(cell):

(work): Drivers License No.:

Social Security No: ___________________

Spouses Social Security No.: ________________ Spouses Drivers License No.: Date of Birth: _________________ Spouses Date of Birth: ______________________

List Other Household Members: 1. 2. 3. 4. 5. 6. _________________________ D.O.B._____________ Relationship: ____________ _________________________ D.O.B.____________ Relationship: _____________ _________________________ D.O.B.____________ Relationship: _____________ _________________________ D.O.B._____________ Relationship: _____________ _________________________ D.O.B._____________ Relationship: _____________ _________________________ D.O.B._____________ Relationship: _____________

RENTAL HISTORY

Present Landlords Address: ____________________________________________ Present Landlords Phone No.: _____________ Amount of Monthly Rent: _________ Date Moved-In: ____________________ Reason for Leaving: ___________________________________________________________________________

Previous Home Address: ________________________________________ City, State, and Zip Code: _______________________________________ Name of Previous Landlord: _____________________________________ Previous Landlords Address: ____________________________________ Previous Landlords Phone No.: ______________ Amount of Monthly Rent: _________ Date Moved-In: _____________________ Date Moved-Out: ______________________ ___________________________________________________________________________ Previous Home Address: ______________________________________ City, State, and Zip Code: _____________________________________ Previous Landlords Name: ___________________________________ Previous Landlords Address: __________________________________ Previous Landlords Phone No.: ______________ Amount of Monthly Rent: ___________ Date Moved-In: _________________ Date Moved-Out: ___________________

EMPLOYMENT HISTORY Present Employer: ______________________________________________ Address: ______________________________________________________ City, State, and Zip Code: _________________________________________ Phone No.: _________________________ Title: ______________________ Length of Employment: __________________ Monthly Income: _________________ Supervisors Name: ______________________ Phone No.: ______________________

Previous Employer: _____________________________________________________ Address: ______________________________________________________________ City, State, and Zip Code: _________________________________________________ Phone No.: __________________________ Title: ____________________________ Length of Employment: _____________________ Monthly Income: ____________ Supervisors Name: _________________________ Phone No.: __________________

Spouses Employer: _____________________________________________________ Address: ______________________________________________________________ City, State, and Zip Code: _________________________________________________ Phone No.: ___________________________ Title: ___________________________ Length of Employment: ___________________ Monthly Income: _______________ Supervisors Name: _______________________ Phone No.: ____________________

Other Income Sources: 1. ________________________ Monthly Income: ___________ 2. ________________________ Monthly Income: ____________ 3. ________________________ Monthly Income: ____________

VEHICLES List all vehicles to be parked by you, your spouse, or any other occupants. Make of vehicle: _____________________ Year: ____________ License No.: __________ Make of vehicle: _____________________ Year: ____________ License No.: __________ Make of vehicle: _____________________ Year: ____________ License No.: __________

EVICTION AND CRIMINAL BACKGOURND HISTORY Have you or any other household member ever been evicted? ______ When? ____________ Have you or any other household member ever been convicted of a felony? ________ When? ______________ Explain: ___________________________________________________________________________ __________________________________________________________________________.

Other Assets Have you owned a home in the last ten years? ___________ If yes list address. ___________________________________________

Do you own other real estate property? ____________ If yes list address ___________________________________________

Are you related to any Blackland Community Development Corporation Board Member? ______________ If yes, which Board Member are you related to and how are you related? ________________________________________________________________.

DEMOGRAPHIC INFORMATION (Optional)

Ethnicity of Head of Household:
Hispanic or Latino Not Hispanic or Latino

Race of Head of Household:

White Asian Native Hawaiian/Other Pacific Islander Asian & White American Indian/Alaskan Native & Black/African American Black/African American American Indian/Alaskan Native American Indian/Alaskan Native & White Black/African American & White Other Multi-Racial

Type of Household (Head of Household):

Single, Non-Elderly Elderly, 62 years + Related/Single Parents Related/Two Parents Other Vacant Disability (Head of Household) Female (Head of Household)

I do not wish to provide this information at this time.

EMERGENCY INFORMATION Please list the name, address and phone no. of a relative or friend to contact in case of emergency: Name: _______________________________________________________________ Address: _____________________________________________________________ Phone No.: ____________________________ Relationship: __________________

PLEASE SIGN THE PERMISSION TO VERIFY AND RELEASE INFORMATION: I give my permission and authorize the Blackland Community Development Corporation to verify the information provided by me on this application regarding my income, employment, rental history, criminal background, and credit history. I understand that my application will be rejected if I have given false information. I also understand that my application will be rejected if I have failed to answer any of the questions asked or provide any of the information requested on this application. I give my permission to Blackland Community Development Corporation to make the information in my files available to agencies or organizations that will be helping me. Information will only be released to the appropriate staff of those agencies or organizations. I understand that all information shared with agencies, organizations, and board members will be kept confidential. I also give my permission for other organizations or agencies to release information in my file to Blackland Community Development Corporation for purposes of housing. Applicants Signature: ____________________________ Date: ____________________

Spouses Signature: ______________________________ Date: ____________________

EMPLOYMENT VERFICATION

Blackland Community Development Corporation requests your assistance in verifying the employment history of _______________________________. Please provide the following information: Dates worked Position Salary I verify that the above information is correct. Signature of Employers Representative:

Date

Permission by Applicant I have given my permission to Blackland Community Development Corporation to verify my employment history. Signature of Applicant: Date