Pre-Application for Affordable Housing UNPHC: Pre-Application for Affordable Housing If you are human, leave this field blank. Please indicate how you heard about us or the Organization that referred you to us by checking all that apply. * Internet Resident (current or former) Vendor Senior Center Homeless Shelter Valley Behavioral Health Independent Living Center House of Hope Drive By YWCA Housing Organization Friend or Relative Volunteers of America TURN Community Services Salt Lake Community Action Davis Behavioral Health Crossroads Urban Center Case Worker Religious Organization Other Other(s) Other Organization or method you heard about us. Add Remove 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. Homeless Physically Disability Mentally Ill Near Homeless Developmentally Disabled Person with Aids Older Persons age 55 & older Older Persons age 62 & older Other Other Type of Disability Not Listed Accessible Unit Required Other Other Type of Disability Not Listed Additionally, for NON-HUD Properties, if any of the following apply, you may be eligible for a preference over all others on the wait list. Please mark all that apply and be prepared to provide documentation. In Jeopardy of Losing Housing Voucher due to no fault of your own. Victim of Domestic Violence and in imminent danger. Victim of Human Trafficking and in imminent danger. 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 * Clear Date * Pre-Application Submittal Checklist (Selection Required) Please mark all properties below that you would like to be added to their waitlist and feel you would qualify based on age and household size. If you submit your application to the Corporate Office without this page being completed, your application will be rejected. It is your responsibility to notify each property you have marked below of any changes to your Pre-Application. Make sure you print a copy of this Pre-Application and Checklist for your records. Age 55 & Older Properties Escalante Park II James E Kier (Liberty Wells) Lowell Apartments The Garden West Jordan II (Jordan Valley) Woodlands Age 62 & Older Properties Brigham City Senior Carl Inoway Dominguez Park LP Escalante Park I & III Glendale Hamilton Place Holly Haven Jerald H Merrill Martha's Terrace Multi-Ethnic Senior Highrise Plymouth View Preston Place Riverview Apartments Sharon Gardens Spring Hollow Village Square I & II West Jordan Family Properties Aspenview Bear River Valley Dominguez Park III Elmhurst/McGregor Holly Haven Jacob Apartments Jared Alan Campbell Court Justin C. Stewart Plaza Lorna Doone Peter Pan Piccardy Preservation Duplexes Riverwood Cove Sedona Smith North Apartments Smith South Apartments Snow Creek Apartments Sophie Apartments Stratford Apartments Willow Park Submit
