Management and Training Corporation - DOC

							Date Received:                                       Time Received:                               # Bedrooms:


Townhomes at Tollgate Creek                                         INTAKE APPLICATION
17236 E. Baltic Pl                                                  FOR SUBSIDIZED HOUSING
Aurora CO 80013
Townhomes at Tollgate Creek does not discriminate against any individual on the basis of race, color,
creed, religion, national origin, ancestry, sex, sexual orientation, marital status, familial status, veteran
status, age or handicap. If, upon qualification and acceptance, it is determined that a reasonable
modification to a unit is necessary to accommodate a handicap, Townhomes at Tollgate Creek agrees to
make the modification, reserving the right to do so at lessee’s expense.

Applicant Full Name:                                                                         Date:       /      /
Address:                                                   City:                    State:           Zip:
Day Telephone:                                             Message Phone: _______
Are you currently homeless?                If so, where are you living?
Household information
List all members who will be living with you

Member No.        Full Name                               Relationship Birthdate Social Security No.
 Head of                                                           Self
Household
        2
        3
        4
        5
        6

Rental History Give a complete history of your residence for the last 2 years.
Please fill out this section completely. DO NOT LEAVE OUT ANY DATES

Current Address:                                                                                     Apt #
City:                             State:          Zip:              Landlord:
Name of Apartment Complex:                                                 Phone:
Amount of rent:                                   Move in date:                     Move out date:
Reason for moving:

Previous Address:                                                                            Apt #
City:                             State:          Zip:              Landlord:
Name of Apartment Complex:                                                 Phone:
Amount of rent:                                   Move in date:                     Move out date:
Reason for moving:

Previous Address:                                                                            Apt #
City:                             State:          Zip:              Landlord:
Name of Apartment Complex:                                                 Phone:
Amount of rent:                                   Move in date:                     Move out date:
Reason for moving:




                                                                                    Summersong Townhomes Intake Application
Date Received:                                      Time Received:                               # Bedrooms:


Employment/Income
Please check all sources of income for the household.

Employment Name of employer___________________________________________________________
           Wage $____________ per Hr/ Week/ Month/ Annual. Hours worked per week __________
           Date Started ____________________________

Social Security/SSI/SSDI Monthly amount received $______________

Public Assistance (TANF, OAP, AND) $________________________

Pensions/Veteran’s Benefits $_________________ How often _____________________

Child Support $______________________ How often _____________________________

Unemployment/Workmen’s Compensation $________________ How often _____________

Alimony $_________________ How Often ________________

Assets
Please check all that apply


_____Checking _____Savings _____Stocks, Bonds, Etc. _____Real Estate _____Other

All applicants must meet our Resident Selection Criteria to be approved. All verifications necessary must be available
at the time of completing a Summersong Townhomes application. All applicants will be subject to a background
verification that includes credit, criminal and eviction history.

Student Status
Please check all that apply

Are any of the household members on these applications that are students at an institution of higher education?
__Yes __No

If “Yes”, which household member/s? ___________________________________________________ ______

Name of educational institution _______________________________________________________________

Are/Is the student/s status full or part time? ____Full time _____Part time

Applicant Certification

The information provided above is true and complete to the best of my/our knowledge and belief. I/We consent to
the disclosure of income and financial information from my/our employer or income provider and financial references
for the purposes of income and asset verification related to my/our application or continued tenancy.



       Applicant (Head of Household)                                      Date




                                                                                   Summersong Townhomes Intake Application
Date Received:   Time Received:                        # Bedrooms:

Co-Applicant                      Date




                                         Summersong Townhomes Intake Application