Name
*
First Name
Last Name
Current Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home/Cell Phone
*
(###)
###
####
Work Phone
(###)
###
####
Email
*
How long have you lived at this address?
*
How many persons in your household, including yourself, WILL LIVE IN THE UNIT FOR WHICH YOU ARE APPLYING?
*
List all of the people WHO WILL LIVE IN THE UNIT FOR WHICH YOU ARE APPLYING, starting with yourself.
*
Please note that Sister Strength Housing studio apartments are only approved for single individuals. Our housing does not accommodate couples or families.
First Name
Last Name
Relationship to Applicant
*
Date of Birth
*
MM
DD
YYYY
Age
*
Sex
*
Female
Male
Transgender
Non-binary
Do not wish to answer
Occupation
*
Household Member 2
First Name
Last Name
Relationship to Applicant
Date of Birth
MM
DD
YYYY
Age
Sex
Female
Male
Transgender
Non-binary
Do not wish to answer
Occupation
Household Member 3
First Name
Last Name
Relationship to Applicant
Date of Birth
MM
DD
YYYY
Age
Sex
Female
Male
Transgender
Non-binary
Do not wish to answer
Occupation
Household Member 4
First Name
Last Name
Relationship to Applicant
Date of Birth
MM
DD
YYYY
Age
Sex
Female
Male
Transgender
Non-binary
Do not wish to answer
Occupation
Are you or any member of your household disabled?
*
Yes
No
If yes, would you describe the disability as:
If you checked either mobility impairment, or visual impairment, or hearing impairment, do you or a member of your household require a special accommodation?
Yes
No
If yes, please specify the special accommodation required.
If Yes, please identify the agency or entity at which you are employed.
City of New York
New York City Housing Development Corporation
New York City Department of Housing Preservation and Development
New York City Economic Development Corporation
New York City Housing Authority
New York City Health and Hospitals Corporation
List all full- and/or part-time employment for ALL HOUSEHOLD MEMBERS including yourself, WHO WILL BE LIVING WITH YOU in the residence for which you are applying. Include self-employment earnings.
*
SELF
First Name
Last Name
Employer Name
*
Employer Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years Employed
*
Household Member 2
First Name
Last Name
Employer Name
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years Employed
Household Member 3
First Name
Last Name
Employer Name
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years Employed
Household Member 4
First Name
Last Name
Employer Name
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Years Employed
List all other income, for example, welfare (including housing allowance), AFDC, Social Security, SSI, pension, disability compensation, unemployment compensation, Interest income, babysitting, care-taking, alimony, child support, annuities, dividends, income from rental property, Armed Forces Reserves, scholarships and/or grants, etc.
SELF
First Name
Last Name
Type of Income
Per
Week
Every Other Week
Month
Quarter
6 Months
Year
Household Member 2
First Name
Last Name
Type of Income
Household Member 3
First Name
Last Name
Type of Income
Per
Week
Every Other Week
Month
Quarter
6 Months
Year
Landlord Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Landlord Phone
*
(###)
###
####
Why are you moving? Please check all that apply.
*
If Other, please specify.
Please provide the name of the bank/branch with whom you have a Checking account.
Please provide the name of the bank/branch with whom you have a Passbook Savings account.
Please provide the name of the bank/branch with whom you have Savings Certificates account.
How did you hear about this housing opportunity?
*
Newspaper
Sign Posted on Property
Local Organization or Church
Friend
City “affordable housing hotline” listing new ads for the month
Web Site/Internet
Other
If Other, please specify.
Ethnic Identification (Used for Statistical Purposes Only)
This information is optional and will not affect the processing of the application. Please check one group that best identifies the applicant.
If Other, please specify.
By typing my name below, I DECLARE THAT STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I have not withheld, falsified or otherwise misrepresented any information. I fully understand that any and all information I provide during this application process is subject to review by The New York City Department of Investigation (DOI), a fully empowered law enforcement agency which investigates potential fraud in City-sponsored programs. I understand that the consequences for providing false or knowingly incomplete information in an attempt to qualify for this program may include the disqualification of my application, the termination of my lease (if discovery is made after the fact), and referral to the appropriate authorities for potential criminal prosecution. I DECLARE THAT NEITHER I, NOR ANY MEMBER OF MY IMMEDIATE FAMILY ARE EMPLOYED BY THE BUILDING OWNER OR ITS PRINCIPALS.
*
First Name
Last Name
Date of Agreement
*
MM
DD
YYYY
Consumer Report Authorization: By typing my name below, I hereby authorize Sister Strength Housing LP. to obtain consumer reports on myself including, but not limited to: Credit Reports, Housing Court Records, Criminal Background Checks and whatever else is necessary to process my application as well as in the future to verify compliance and/or should I default on my lease. I understand that date of birth is necessary to obtain Criminal Background Reports and will not otherwise be used in evaluating my application. I also agree to hold Sister Strength Housing LP and its affiliates harmless for any claims that may arise as a result of this investigation.
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Date of Consumer Report Authorization
*
MM
DD
YYYY
