Apply for Housing | Be A Helping Hand

1Eligibility Screening

2Rental Application

3General Info & References

4Release Authorization

5Income Questionnaire

6Assets & Certification

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Affordable Rental Housing Program

Application and Income Questionnaire — Eligibility Screening

To all prospective Applicants:
Please read carefully the information below and answer the questions.

If you answer YES to question 1 and NO to questions 2–4, then you are eligible to submit an application and be considered for our affordable housing rental program.

If not, then you are currently ineligible for any of our rental units.

Level 1 (30% AMI)

Household Size Income

One $16,800

Two $19,200

Three $21,600

Four $24,000

Five $25,950

Six $27,850

Seven $29,800

Eight $31,700

Level 2 (50% AMI)

Household Size Income

One $28,000

Two $32,000

Three $36,000

Four $40,000

Five $40,450

Six $46,400

Seven $49,600

Eight $52,800

Level 3 (60% AMI)

Household Size Income

One $33,600

Two $38,400

Three $43,200

Four $48,000

Five $51,840

Six $55,680

Seven $59,520

Eight $63,360
Level 4 (80% AMI)

Household Size Income

One $44,800

Two $51,200

Three $57,600

Four $64,000

Five $69,150

Six $74,250

Seven $79,250

Eight $84,500

Level 5 (120% AMI)

Household Size Income

One $67,200

Two $76,800

Three $86,400

Four $96,000

Five $103,700

Six $111,350

Seven $119,050

Eight $126,700
1. Is your household income below the income levels listed in the charts above?*
- Yes
- No
Which income level applies to your household?*
- Level 1 (30% AMI)
- Level 2 (50% AMI)
- Level 3 (60% AMI)
- Level 4 (80% AMI)
- Level 5 (120% AMI)
2. Have you been evicted from Federally-assisted housing for drug-related criminal activity in the last 3 years?*
- Yes
- No
3. Have you or any member of your household been convicted of a violent criminal activity in the past 3 years?*
- Yes
- No
4. Are you or any member of your household subject to a lifetime registration requirement or currently registered under a state sex offender registration program?*
- Yes
- No
Applicant Signature*
Sign to confirm your eligibility answers above are truthful.
Date*
MM slash DD slash YYYY

Household Size	Income
One	$16,800
Two	$19,200
Three	$21,600
Four	$24,000
Five	$25,950
Six	$27,850
Seven	$29,800
Eight	$31,700

Household Size	Income
One	$28,000
Two	$32,000
Three	$36,000
Four	$40,000
Five	$40,450
Six	$46,400
Seven	$49,600
Eight	$52,800

Household Size	Income
One	$33,600
Two	$38,400
Three	$43,200
Four	$48,000
Five	$51,840
Six	$55,680
Seven	$59,520
Eight	$63,360

Household Size	Income
One	$44,800
Two	$51,200
Three	$57,600
Four	$64,000
Five	$69,150
Six	$74,250
Seven	$79,250
Eight	$84,500

Household Size	Income
One	$67,200
Two	$76,800
Three	$86,400
Four	$96,000
Five	$103,700
Six	$111,350
Seven	$119,050
Eight	$126,700

Be A Helping Hand Foundation – Rental Application
Property & Occupant Information
Property Address
Street Address City State ZIP Code
Unit Type
Rent Amount
Desired Occupancy Date
MM slash DD slash YYYY
Lease Term
Other Lease Term (please specify)
Security Deposit
Important: All applicants 18 years of age and older, not related by blood, marriage, or adoption, must complete their own application.
Persons Occupying Unit
List all persons who will occupy the unit.
Number of People in Household
Select how many people will live in the unit (up to 5). Fields will appear for each person.
Person 1
Person 1 – Name
First Middle Last
Person 1 – Relationship
Person 1 – Social Security Number
Person 1 – Date of Birth
MM slash DD slash YYYY
Person 1 – Student?
Person 2
Person 2 – Name
First Middle Last
Person 2 – Relationship
Person 2 – Social Security Number
Person 2 – Date of Birth
MM slash DD slash YYYY
Person 2 – Student?
Person 3
Person 3 – Name
First Middle Last
Person 3 – Relationship
Person 3 – Social Security Number
Person 3 – Date of Birth
MM slash DD slash YYYY
Person 3 – Student?
Person 4
Person 4 – Name
First Middle Last
Person 4 – Relationship
Person 4 – Social Security Number
Person 4 – Date of Birth
MM slash DD slash YYYY
Person 4 – Student?
Person 5
Person 5 – Name
First Middle Last
Person 5 – Relationship
Person 5 – Social Security Number
Person 5 – Date of Birth
MM slash DD slash YYYY
Person 5 – Student?

Prefer to print the application?

Application for Housing

Affordable Rental Housing Program

Level 1 (30% AMI)

Level 2 (50% AMI)

Level 3 (60% AMI)

Level 4 (80% AMI)

Level 5 (120% AMI)

Be A Helping Hand Foundation – Rental Application

Persons Occupying Unit

Person 1

Person 2

Person 3

Person 4

Person 5

General Information

B. Housing Reference

1. Present Address

2. Previous Address

C. Personal References

Release Authorization

Applicant / Resident 1

Applicant / Resident 2 (if applicable)

TERMS AND CONDITIONS

Tenant Income Questionnaire

Household Members

Person 1

Person 2

Person 3

Person 4

Person 5

Income Information

Asset Information

Student Status

Applicant / Tenant 1 Certification

Applicant / Tenant 2 (if applicable)

Supporting Documentation

RETURN THE COMPLETED FORMS AND REQUIRED DOCUMENTATION TO: