Pre-Application for Affordable Housing | Utah Non-Profit Housing Corporation

Please indicate how you heard about us or the Organization that referred you to us by checking all that apply.

Other(s)

Other Organization or method you heard about us.

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Head of Household Information

Name (First, Middle Initial, Last) *

Date of Birth *

Number in Household *

Unit Size Requested

Household Gross Income *

Current Street Address *

City, State & Zip

Daytime Phone *

Evening Phone *

Email

Optional Question: Marking any of the following may entitle you to higher placement on the wait list. Marking any of these will in no way affect the eligibility of your application.
Please mark all that apply to all applicants listed above on your application.

If you choose not to complete this data check this box.

Please mark all that apply to all applicants listed above on your application.

Other

Other Type of Disability Not Listed

Please answer the following questions considering each member of the household.

Are you or any other household member subject to any (including lifetime) state sex offender registration program in any state? If yes, who?

Yes

No

If yes, who?

Signature Clause

I certify that to the best of my knowledge all above information is true and correct. I understand that providing false information or making false statements may be grounds for denial of my pre-application. I understand that this 'Pre-Application' is only for placement on my selected waitlist(s) and that I/we must complete a full 'Application' when I am contacted by a UNPHC Representative. In addition, my/our occupancy is contingent on meeting management's resident selection criteria and program requirements.

Signature

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Date