Hoosier Uplands Rental Application RD

If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
  • 1 Hoosier Uplands - Rental Housing Application - RD
    Please click here to download a printable version of the Hoosier Uplands - Rental Housing Application - RD and fill out manually

    Rental Housing Application


    Name of the apartment complex you are applying for
    Name of Applicant
    *
    (First, Middle Initial, Last)
    Name of Co-Applicant
    (if applicable - additional applicant must be completed)
    Applicant Email Address
    *
    Applicant Phone Number
    *
    Application Type
    Marital Status
    Driver's License Number
    Driver's License State


    Rental History

    Last two years
    Current Address
    City
    State
    Zip
    Start Date of Occupancy
    End Date of Occupancy
    Monthly Payment
    Approximate monthly cost of utilities paid by you (excluding phone and TV):

    Reason for Moving

    How?
    Present Landlord Name
    Landlord Phone Number
    Previous Address
    City
    State
    Zip
    Start Date of Occupancy
    End Date of Occupancy
    Monthly Payment
    Approximate monthly cost of utilities paid by you (excluding phone and TV):

    Reason for Moving

    How?
    Previous Landlord Name
    Landlord Phone Number


    Household Composition

    List all persons that will be occupying the unit
    Full Name
    Relationship to Head of Household
    Date of Birth
    Social Security Number
    Total Annual Income

    Total Number of Occupants

    If yes, please explain


    GENDER / RACE / ETHNICITY STATUS

    The information regarding sex designation, race, and ethnicity are requested to assure the Federal Government, acting through the Rural Housing Service, that federal laws prohibiting discrimination against tenant applications on the basis on race, color, national origin, religion, sex, familial status, age, and disability are complied with. This information will not be used in evaluating your application or to discriminate against you in any way
    First Name
    Gender


    Disability Status

    If you require an accommodation, please list specific modifications needed:


    Attendant

    If a care attendant will be living with you permanently or on a periodic basis, please list:
    Name of Care Attendant:
    A criminal background check of the Attendant is required.
    Phone Number:


    Student Status

    If yes, please explain:


    General Questions

    Name and phone # of childcare provider

    (Not all properties allow pets and certain breeds may not be allowed)
    Please list breed and weight


    Character References

    Name
    Relationship
    Phone
    Name
    Relationship
    Phone


    Medical

    If you answer yes to either of the two questions below, you will be asked to complete Form #20A-Expense List.

    Elderly is defined as an individual who is 62 years old or older.


    Emergency Contact Number

    In case of emergency, please notify
    Name
    Home Phone
    Work Phone
    Applicant certifies the above information is true and accurate and understands that false or inaccurate information shall be cause for denial of this application or termination of any subsequent rental agreements. I/We are the only person(s) who will reside in the apartment if this application is approved. Apartment owner or agents may verify all information given directly or through reporting agencies. Acceptance of the application is not binding on apartment owner or agent until approved in writing.

    You have applied to live in an apartment that is governed by the Low-Income Housing Tax Credit Program. This Program requires us to certify all of your income asset and eligibility information as part of determining your household’s eligibility. Program requirements state we must verify each income and asset source as well as other claims of eligibility. We must
    determine this prior to granting your eligibility and, if such eligibility is granted, each subsequent year you remain in the unit. The undersigned is the person(s) named above and hereby authorizes Apartment Credit Services to conduct a search of my Criminal Record, Police Record and Motor Vehicle Record information for the purpose of obtaining housing. Additionally, I authorize all companies and law enforcement agencies to release such information and release them from any liability and responsibility from doing so. A faxed copy of this authorization shall be as valid as the original.

    If applicant cancels after two (2) days, all moneys deposited shall be forfeited to the apartment owner. If approved all moneys deposited with this application will be applied toward security deposit and/or processing fee at owner’s discretion. If an application is denied for ANY reason a 90-day wait period is required before reapplying to this property.
    Head Signature
    *
    Co-head Signature
    Co-Applicant Signature
  • 2 Hoosier Uplands - Authorization to Release Information
    Please click here to download a printable version of the Hoosier Uplands - Authorization to Release Information and fill out manually

    Authorization to Release Information

    Name of the apartment complex you are applying for
    Applicant Contact Information
    Applicant Name
    *
    (First, Middle Initial, Last)
    Email Address
    *
    Phone Number
    *
    The undersigned individual(s) has applied for residency at _PROPERTY_. The property is operated under federal affordable housing regulations, which require that we obtain written confirmation of the eligibility of all applicants and household members. In order to comply with federal regulations, please complete the following form in full and return it to the sender at your earliest convenience.

    Verifications and inquiries that may be requested include, but are not limited to:
    • Credit and Criminal Activity 
    • Identity and Marital Status 
    • Previous Residences and Rental Activity
    • Employment, Income, and Assets 
    • Medical Allowances 
    • Student Status
    The groups or individuals that may be asked to release/verify the above information (depending on program requirements) include, but are not limited to:
    • Courts and Post Offices
    • Law Enforcement Agencies
    • Medical Providers
    • Retirement Systems
    • Banks and Other Financial Institutions
    • Past and Present Employers
    • State Unemployment Agencies 
    • Veterans Administration
    • Social Security Administration 
    • Previous Landlords (Including PHA’s)
    • Utility Companies
    • Credit Providers and Bureaus 
    • Welfare Agencies
    • Internal Revenue Service

    I/we agree that a photocopy of this authorization may be used for the purposes stated above. The original signed copy of this authorization is on file in the management office and will stay in effect for two years from the date signed. I/we understand that I/we have a right to review my/our file and correct any information that can be proven incorrect. The undersigned hereby authorizes the release of any information requested in order to determine my/our eligibility for the federal affordable housing program.
    Applicant Signature
    *
    Applicant or Resident Name
    Last 4 Digits of Social Security Number
    Co-Applicant Signature
    Co-Applicant or Co-Resident Name
    Last 4 Digits of Social Security Number
  • 3 Hoosier Uplands - Background Check Release
    Please click here to download a printable version of the Hoosier Uplands - Background Check Release and fill out manually

    Applicant Criminal Background Check Release and Authorization Form

    Name of the apartment complex you are applying for
    Applicant Contact Information
    Applicant Name
    *
    (First, Middle Initial, Last)
    Email Address
    *
    Phone Number
    *
    I, {APPLICANT_NAME} hereby authorize Hoosier Uplands or other authorized representative of the apartment community bearing this release, or copy thereof, to obtain any information pertaining to criminal court records. I hereby direct you to release such information to Hoosier Uplands or other authorized representatives of the apartment community.

    I, {APPLICANT_NAME} hereby fully release and discharge Hoosier Uplands, and their employees, agents, attorney, and their respective affiliates from all claims and damages arising out of or relating to any investigations of my background for residency.
    Current Address
    City
    State
    Zipcode
    How long at this address?
    Previous Address (if less than one year at the above address):
    Street
    City
    State
    Zipcode
    Other Name, Alias, Maiden Name
    Date of Birth
    Social Security #
    Have you ever been convicted for any crime, including sex-related or child abuse related offenses?
    please provide detailed explanation

    Please sign your name below

    *

    12/05/2025

If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
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