MM Application – Maple Manor Apartments

Name*

First Last

Your Email

Date of Birth*

Birthplace*

Citizenship*

Present Address*

Street Address City State ZIP Code

Family member's or other social security number:

Your Phone Number*

Alternate person to contact in the event we are unable to reach you:

First Last

Their Phone Number

Do you own or rent?*

Own
Rent

Landlord's Name*

First Last

Landlord's Address

Street Address City State ZIP Code

Landlord's Phone Number

Have you ever been evicted for any reason?*

If yes, has your subsidized housing ever been terminated for fraud, non-payment of rent, or failure to cooperate with re-certification procedures? Explain.*

Do you wish to be placed on our waiting list if there is no available unit right now and you are elgible?*

1 Person
2 People

Are you willing to take an available unit at Maple Manor in the event your name appears at the top of our waiting list?*

If Yes, Please explain.*

Income Limits

Income Limits for Residency at Maple manor (revised March 2007) Please check the box that your annual income does not exceed

Extremely Low Income

$14,800 (One Person)
$16,900 (Two Person)

Very Low Income

$24,650 (One Person)
$28,200 (Two Person)

Low Income

$39,450 (One Person)
$45,050 (Two Person)

Please list any other information that would help us determine your eligibility for residency at Maple Manor in accordance with eligibility criteria state at Maple Manor's letter of interest in the Eligibility, Income and Verification section.

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Phone

This field is for validation purposes and should be left unchanged.