Hud Application For Housing Template printable pdf download

Shepherd’s Garden

6927 196

St. SW

Lynnwood, WA 98036

Phone (425) 744-1610

TDD (800)545-1833 ext. 478

E-mail:

Web:

PPLICATION

ACKET

Dear Prospective Applicant,

Thank you for your interest in applying for an apartment at Shepherd’s Garden. Shepherd’s Garden provides

housing for senior households that has at least one household member must be age 62 or older at time of application.

All information requested in the application packet must be completed. Incomplete applications will not be

considered. If the information requested does not apply to you, please indicate by using “N/A” for not

applicable. This will tell us that you understand the requested information and you did not intentionally leave it

blank. If you make a mistake or typo, please draw a single line through the errors and put your initial. Please do

not use whiteout to correct the errors.

Please check that you have completed, signed, and returned the following forms:

o Application for Housing

o HUD-92006 Emergency Contact Information Form

o HUD-27061-H Race and Ethnicity Data Form (Attached is one form for the head of household. If

you have additional members, please request an additional form at the office.)

Once the application is received, it will be determined whether you preliminarily qualify to be placed on the

waiting list. If you do not qualify, you will be notified in writing. We purge our waiting list twice per year.

Please remember to notify us when you change your address and phone number or contact information. If you

don’t respond to us whether or not you still want your name to remain on the waiting list, you will be removed

from our waiting list.

The apartments are offered as they become available. As your name reaches the top of the waiting list, you will

be required to come in for an interview. At that time, you will be asked to sign the authorization forms which

allows our staff to further verify your age, income, assets, allowances, criminal history, sex offender status,

credit history and landlord references.

If you have any questions, please contact our office at the phone number listed above.

EQUAL HOUSING OPPORTUNITY

Shepherd’s Garden does not discriminate on the basis of handicapped status in the admission or access to, or treatment or employment in its federally

assisted programs and activities. Our Fair Housing Coordinator is designated to ensure compliance with the nondiscrimination requirements

contained in Section 504 of the HUD Regulations and can be contacted via e-mail at or at 6120 Stoneridge Mall Road,

Third Floor, Pleasanton, CA 94588, Telephone 925-924-7116 TDD 800-545-1833 Ext 478.

Hud Application For Housing Template