Washtenaw Affordable Housing Corporation
701 Miller Avenue #4, P.O. Box 3940, Ann Arbor, MI 48106
Phone 734-747-6824 / Fax 734-747-7956 / Email wahc@comcast.net

WAHC HOUSING APPLICATION

All WAHC properties are subject to limitations based on family size and income. This application must be complete and signed by all adult applicants. All identified sources of income must be documented with attached copies of recent paystubs and/or award letters.

Please print this form, complete it, and mail or fax it to WAHC with all supporting documentaton and a $25 check (application fee) made out to Washtenaw County Nonprofit Affordable Housing Corporation (mail the check separately if submitting the application via fax).

1. Applicant (all proposed occupants age 18 or older):

Applicant Name	_________________________________
Soc. Sec. No.	_________________________________
Date of Birth	_________________________________
Sex	_________________________________
Marital Status	_________________________________

2. Contact Information:

Current Home Address		_____________________
City		_____________________
St.		_____________________
Zip		_____________________
How long at this address		_____________________
Rent Amount		_____________________
Day Phone#		_____________________
Night Phone#		_____________________
Landord Address		_____________________

Previous Home Address		_____________________
City		_____________________
St.		_____________________
Zip		_____________________
How long at this address		_____________________
Rent Amount		_____________________
Day Phone#		_____________________
Night Phone#		_____________________
Landord Address		_____________________

3. I/we are applying for housing at:

	701 Miller (Parkside Apartments)
	723 S. Main (Southside Apartments)
	1500 Pauline (Parkhurst Apartments)
	Gateway Sgl. House
	First Available

4. Please list all proposed occupants other than Applicants:

Sr.No.	Name	Relation	Age
1.	________________________________	_____________	___
2.	________________________________	_____________	___
3.	________________________________	_____________	___
4.	________________________________	_____________	___

5. Please detail all sources of verifiable income for occupants 18 or older:

Employer	Position	How Long?	Pay Rate	Avg. Monthly
______________	______________	______________	$ ______________	$ ______________
______________	______________	______________	$ ______________	$ ______________
			OTHER INCOME
			Soc. Security	$_____________
			Pension	$_____________
			Disability	$_____________
			Child Support	$_____________
			Other	$_____________
			Total Other Income:	$_____________

6. Please provide answers to all questions, and detailed answer to any Yes for items 3 to 6 on separate page.

		Y/N
1.	Does this Household currently have Sec. 8 assistance?	____
2.	Do you have any pets?	____
3.	Has any applicant ever been evicted from rental housing?	____
4.	Has any occupant been convicted of sale, use, or manufacture of illegal drugs?	____
5.	Has any occupant been notified of a Lease violation?	____
6.	Is any adult household member a Full Time student?	____

7. Please provide contact information for one nonrelated personal reference:

Name	__________________________________
Address	__________________________________
Phone	__________________________________

8. Please provide an emergency contact:

Name	__________________________________
Address	__________________________________
Phone	__________________________________

9. If your employment is less than one year, provide previous employment information for last two years:

Dates	Employer	Pay Rate	Avg. Monthly	Reason for leaving?
____________	________________	$____________	$____________	________________________
____________	________________	$____________	$____________	________________________

10. Please provide financial information:

	Name of Bank	Balance
CHECKING ACCOUNT:	_____________________________	$__________________
SAVINGS ACCOUNT:	_____________________________	$__________________

11. Debt Payments:

Car Payment	$ ______________/mo
Credit Cards	$ ______________/mo
Child Support	$ ______________/mo
Student Loans	$ ______________/mo
Other	$ ______________/mo

Have you ever filed for bankruptcy? Yes No

If yes, when and why?

12. Why do you want or need to move?

I understand that WAHC is relying on the information provided above to certify my eligibility to participate in any WAHC rental program, and I agree to the release of any information by third parties to verify this information for initial approval and continued eligibility.

I Agree I Decline

Print Name: ____________________________________

Sign Name: ____________________________________

Date: _________________________________________