Applicants must meet income eligibility requirements and successfully pass a criminal background check and have favorable landlord references. To be eligible, applicants must not have a history of drug related, violent or sexual related offenses. The Fax number is 435-722-2170.



    Household Information: Complete the following information for each household member that will occupy the unit at time of move-in:

    (First, Last, MI)
    Relationship to the
    Head of Household
    Birth Date
    Social Security
    1st Choice:
    2nd Choice:
    Would you or anyone in your household benifit from a special needs unit? (Mobility, vision, or hearing impairment)
    Will you or anyone in your household require a live-in care attendant?
    Name of Live-In Care Attendant:
    Relationship (If any):



    If YES, explain
    If YES, explain
    If YES, explain
    If YES, explain
    If YES, provide the nature of the crime(s):
    Date: State: City:
    Are any of the above convictions a felony?
     If Yes, Please explain 
    If YES, where?
    From: To:
    Were you evicted?: If Yes, Why?
    If YES, explain
    If YES, give reason Date of filing:
    If YES, where

    Earned income is counted only for household members 18 or older and members who are legally emancipated. Unearned income such as a grant or benefit is counted for all household members, including minors.

    Include all GROSS income (before taxes) each household member expects to earn in the next 12 months. (Check either YES or NO to each question.)

    Do YOU or ANYONE in your household receive OR expect to receive income from:

    (We must count court ordered support whether or not it is received unless legal action has been taken to remedy. We must also count support that is not court-ordered, rather, received directly from the payer.)

    Name of Agency:
    Name of Court:
    Name of Person:


    If YES, explain:

    If YES, Who?

    Include all assets and the corresponding annual interest rate, dividends or any other income derived from the asset. An asset is defined as any lump sum amount that you hold in your name and currently have access to. Include the value of the asset and corresponding income from the asset in the space provided.

    Are any of the above listed trusts irrevocable?

    Do you or anyone listed above own a vehicle?

    Vehicle Identification:

    1 License #:
    State Issued:
    2 License #:
    State Issued:

    All questions that were answered YES on this application will be verified through the appropriate third-party source. It will be your responsibility to provide management with all necessary information to properly process your application and verify your eligibility. This will include names, addresses, phone and fax numbers, account numbers (where applicable), and any other information required to expedite this process.

    I understand that management is relying on this information to prove my household's eligibility for housing assisted under a program of the U.S. Department of Housing and Urban Development (HUD). I certify that all information and answers to the questions are true and complete to the best of my knowledge. I consent to release the necessary information to determine my eligibility. I understand that providing false information or making false statements may be grounds for denial of my application. I also understand that such action may result in criminal penalties.

    I consent to have management verify the information contained in this application for purposes of proving my eligibility for occupancy. I will provide all necessary information and expedite this process in anyway possible. I understand that my occupancy is contingent on meeting management's resident selection criteria and the HUD Neighborhood Stabilization Program.

    I understand that in compliance with the FAIR CREDIT REPORTING ACT the processing of this application includes but is not limited to making any inquiries deemed necessary to verify the accuracy of the information I provided, including procuring consumer reports from consumer credit reporting agencies and obtaining credit information from other credit institutions.