Pre-Application for Affordable Housing UNPHC: Pre-Application for Affordable Housing 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 - 1660 West 1000 North, SLC JAMES E KIER (Liberty Wells) - 260 East 800 South, SLC LOWELL APARTMENTS - 756 South 200 East, SLC THE GARDEN - 10850 South Beckstead Lane, South Jordan WEST JORDAN II (Jordan Valley) - 7832 South 3200 West, West Jordan WOODLANDS - 441 East 900 South Brigham City Age 62 & Older Properties BRIGHAM CITY SENIOR - 367 North Main, Brigham City CARL INOWAY - 690 South Riverwalk Parkway, Logan DOMINGUEZ PARK LP - 3990 South 700 West, SLC ESCALANTE PARK I & III - 1040 North Redwood Road, SLC GLENDALE - 1239 South Glendale Drive, SLC HAMILTON PLACE - 764 South 800 East, SLC HOLLY HAVEN - 1100 South 1000 East, Clearfield JERALD H MERRILL - 8923 West 2700 South, Magna MARTHA'S TERRACE - 2617 South 9040 West, Magna MULTI-ETHNIC SENIOR HIGHRISE - 120 South 200 West, SLC PLYMOUTH VIEW - 4764 Plymouth View Drive, Taylorsville PRESTON PLACE - 2673 South Preston (1935 East), SLC RIVERVIEW APARTMENTS - 135 South 100 East, Tremonton SHARON GARDENS - 3354 South Sue Street, SLC SPRING HOLLOW - 1360 North 200 East, Logan VILLAGE SQUARE I & II - 600 East 6th Street, Ogden WEST JORDAN - 2105 West Sugar Factory Road, West Jordan Family Properties ASPENVIEW - 1230 East Elgin Avenue (no office), SLC BEAR RIVER VALLEY - 767 West 600 South, Tremonton CANYON ECHO - 2215 East 3300 South, SLC DOMINGUEZ PARK III - 3970 South 700 West, SLC ELMHURST/McGREGOR - 810 25th Street, Ogden HOLLY HAVEN - 1100 South 1000 East, Clearfield JACOB APARTMENTS - 303 East 600 South, SLC JARED ALAN CAMPBELL COURT - 1596 West 3395 South, WVC JUSTIN C. STEWART PLAZA - 7986 West 3500 South, Magna LORNA DOONE - 135 South 300 East, SLC PETER PAN - 445 East 300 South, SLC PICACARDY - 115 South 300 East, SLC PRESERVATION DUPLEXES - Multiple Locations (No Office), SLC RIVERWOOD COVE - 582 North Riverside Drive, SLC SEDONA - 562 West 200 North (no office), SLC SMITH NORTH APARTMENTS - 228 South 300 East, SLC SMITH SOUTH APARTMENTS - 682 East 700 South, SLC SNOW CREEK APARTMENTS - 221 North Fairfield Road, Layton SOPHIE APARTMENTS - 925 South 200 West, SLC STRATFORD APARTMENTS - 169 East 200 South, SLC WILLOW PARK - 3746 Desert Willow Dr. (3375 W), WVC Submit If you are human, leave this field blank.