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.



Waitlist Application

    Thank you for your interest in the Uintah Basin Housing’s apartment community. Please choose below which apartment complex that you would like to apply for:

    a)  All household members over the age of 18 must pass a credit & criminal background check
    b)  All household members over the age of 18 must pass a prior rental check (if applicable)
    c)  All household income and assets must be verified

    Please keep in mind that this pre-qualification packet does NOT qualify you for an apartment with our housing agency. This packet, if completed correctly, will place you on the waitlist for the property of your choice. Once you have reached the top of the properties waitlist, management will contact you to start your qualification process.

    Be aware that falsification of any information on the application is cause for automatic rejection.
    See last page for application return methods

    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
    If YES, explain
    If YES, explain how many members will be added or reduced, and when that change will take place.
    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 

    Are you or any members of your household subject to a lifetime registration requirement under a state sex offender registration program?
     If Yes, Please explain 
    Are there any criminal charges pending now?
     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:

    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.

    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), Low Income Tax Credit (LIHTC), USDA Rural Development (RD) or state HOME funds. 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 any way possible. I understand that my occupancy is contingent on meeting management’s resident selection criteria and the applicable program requirements.

    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.