Spokane Housing Ventures

Move In Date

Move Out Date

Previous Address

Landlord/Owner Name

Daytime Phone:

715 East Sprague Avenue Suite 102 · Spokane, Washington 99202 · Voice: (509) 232-0170 · Fax: (509) 484-4617

Rental Application

INSTRUCTIONS: Please enter all information correctly and completely. Missing, incomplete or fraudulent information is grounds for rejection. In order to process your application quickly, please attach most recent tax return or 4506T (IRS transcript), copies of picture ID for all adults, and copies of social security cards for all family members. All non-married adult applicants must complete separate applications. Mail or bring the completed application to the address above (if you mail the application be sure to let us know how to contact you). If you appear to be qualified based on the information submitted, you will be asked to pay the Application Fee ($31 per adult and $12 for each 16-17 year old for most properties). Do not enclose the fee with the application.

Spokane Housing Ventures has a “no cash” policy. Please pay fees, rents and deposits in the form of a check or money order only. Make checks or money orders for screening fees out to T.I.S., the background screening service.

If you need assistance completing this application or have any questions regarding this form, the application process or a prospective unit, please contact resident services manager at (509)232-0170 Ext. 205.

PROPERTY: I am interested in renting:

Studio 1 BR

5th & Wash.

Casas Salvadas

CJ Court

Cottonwood II

El Estero

2BR 3BR

Hidden Pines

Medical Lake

Scattered Sites

Triplex Project

Village Apts.

4 BR Other

Wilton Apts.

Woodruff Hts.

APPLICANT INFORMATION:

Applicant Name:	Jr. Sr. Etc.:	Full Time Student: Yes No
Current Address:	Telephone:	Rent Amount:
City, State, Zip:	Date of Birth:	Are you 18 or older? Yes No
SSN:	Have you ever used a different SSN or last name? Yes No Please explain:
Driver's License #:	State Of Issue:
Co-Applicant Name:	Jr. Sr. Etc.:	Full Time Student: Yes No
Current Address:	Telephone:	Rent Amount:
City, State, Zip:	Date of Birth:	Are you 18 or older? Yes No
SSN:	Have you ever used a different SSN or last name? Yes No Please explain:
Driver's License #:	State Of Issue:

SHV Rental Application -- page 2 of 5

OCCUPANT INFORMATION: Please list names of other occupants who will be living at this residence. Attach additional sheet if necessary.

Last Name	First Name	SSN	Gender (circle)	Birth Date	Full Time Student?
			M F		Y N
			M F		Y N
			M F		Y N
			M F		Y N
			M F		Y N

RESIDENCE HISTORY: Please provide at least 3 years of rental history. Attach an additional sheet of paper if necessary.

EMPLOYMENT REFERENCE: Please list your current employer. If unemployed, state so.

Current Employer

Supervisor

Phone

Position

How Long?

Applicant

Co-app.

INCOME: Please identify source, name of recipient and amount of current income.
Is your income seasonal or sporadic? Yes No

Applicant Current Income	Recipient's Name	Monthly Amount	Co-Applicant Current Income	Recipient's Name	Monthly Amount
Employment			Employment
Child Support/Alimony			Child Support/Alimony
SSA			SSA
SSD			SSD
SSI			SSI
VA			VA
L&I			L&I
DSHS			DSHS
Food Stamps			Food Stamps
Other			Other

SHV Rental Application -- page 3 of 5

PERSONAL REFERENCE/EMERGENCY CONTACT: Please list two personal references as well as an emergency contact.

Name	Address	Phone	Relationship


			Emergency Contact

CURRENT HOUSING, REFERRAL AND/OR SPECIAL NEEDS: Please circle all that apply.

Current Housing Type:	Referred by:	Special Housing Needs:
House	Self	Ground Floor
Doubled up with another family	Newspaper	Wheel chair accessible
Transitional Housing Apartment	Sign for rent	Ramp
Shelter	Flyer	Barrier free
Homeless	Church	Hearing- or sight-accessible smoke detectors
Car/streets	Housing Authority	English as a second language
Treatment Center	Social service staff	Live-in caretaker
	Outreach team
	Alcohol/drug program
	Mental health program
	Emergency housing program
	Hospital
	Other

MISCELLANEOUS: Please answer all questions.

Are you currently receiving a Section 8 voucher or certificate?		Yes No
Have you or any member of your household ever been evicted from your home?		Yes No
Do you own a vacuum cleaner or do you have access to one on a regular basis?		Yes No
Within the last seven years, have you or any member of your household filed bankruptcy?		Yes No
If yes, is the bankruptcy discharged?		Yes No
Are you or any member of your household currently having your wages garnished?		Yes No
Have you or a household member ever been charged with illegal manufacture or distribution of a controlled substance?		Yes No
Have you or a member of your household ever been convicted of a crime?		Yes No
Describe Offense:	Year convicted:

SHV Rental Application -- page 4 of 5

MISCELLANEOUS (continued):

Are you or any member of your household a registered sex offender in any state?	Yes No
Are you or any member of your household required to register your address with a corrections office or with police personnel?	Yes No
Do you own a pet? (Please inquire about our pet policy.)	Yes No
Do you own a waterbed? (Please inquire about our insurance policy.)	Yes No

OPTIONAL INFORMATION: TO BE USED ONLY FOR EQUAL OPPORTUNITY COMPLIANCE MONITORING PURPOSES.

Spokane Housing Ventures is committed to offering equal housing opportunities to qualified individuals and families and does not discriminate with regard to race, color, religion, gender, disability, familial status (having children), national origin, marital status or sexual orientation. Your answers to these questions are optional and will be used only to help us determine our compliance with equal opportunity guidelines.

APPLICANT:

Gender:	Male	Female
Marital Status:	Married	Separated	Single (Divorced, Widowed, Never Married)
Race/Ethnic Origin	Alaskan Native Native American Bi-racial Black, non-Hispanic Hispanic Pacific Islander/Asian White, non-Hispanic Other (specify)

I do not wish to furnish this information. _____ (initial)

CO-APPLICANT:

Gender:	Male	Female
Marital Status:	Married	Separated	Single (Divorced, Widowed, Never Married)
Race/Ethnic Origin	Alaskan Native Native American Bi-racial Black, non-Hispanic Hispanic Pacific Islander/Asian White, non-Hispanic Other (specify)

I do not wish to furnish this information. _____ (initial)

SHV Rental Application -- page 5 of 5

Release of Information and Authorization to Verify

I (we), ______________________________________________ understand that all information provided herein to Spokane Housing Ventures as part of my (our) application for tenancy will be thoroughly reviewed by staff and or their agents. I (we) hereby certify that this application has been made freely and voluntarily, and that the information entered above is accurate to the best of my (our) knowledge.

I (we) understand that knowingly providing any false information is grounds for denial.

I (we) hereby authorize Spokane Housing Ventures to verify the information herein in order to evaluate my (our) eligibility for tenancy. I (we) understand that verification will require inquiries to past and present employers and other income sources, past and present landlords, and social service agencies. It may also require obtaining credit reports and examination of public records and databases. Credit reports and public records will be obtained from third party sources and I understand that I have a right to dispute the accuracy of any information they may contain. I understand that all information submitted herein and which SHV may obtain from other sources for verification purposes will be held in strict confidence by SHV, and not used for any purpose, or disclosed to any parties, not related to evaluating my (our) eligibility for tenancy.

_______________________________________ _____________________________________

Signature Date

_______________________________________ _____________________________________

Signature Date

To appeal or dispute the decision of Spokane Housing Ventures, please submit it in writing to:

Spokane Housing Ventures, 715 E Sprague Avenue, Suite 102, Spokane, WA 99202.

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