AUTHORIZATION
All applicants over the age of 18 years must complete the sections below, as applicable.
To apply for community housing, you MUST agree to the two points below. I/We authorize
Capital Region Housing to make any
inquiries necessary to any government office, organization,
agency or individual for the purposes of verifying information provided in this application.
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Capital Region Housing to contact and receive information from current and/or previous
landlords to complete reference checks for the purposes of assessing suitability as a
prospective tenant.
Initial Initial Initial Initial Initial Initial
The following two are OPTIONAL. You do not need to agree to these in order to apply for
community housing. I/We authorize:
Capital Region H
ousing to contact me for research purposes – all information will remain
anonymous, and I/we can decline participation at any time.
Initial Initial Initial Initial Initial Initial
Capital Region Housing to use my email address for the purposes of communication including, but
not limited to, newsletters, surveys and information.
Initial Initial Initial Initial Initial Initial
I/We understand:
This application is not an agreement on the part of Capital Region Housing to provide me/us with
housing.
A failure to respond to requests for additional information or documentation by Capital Region Housing
may result in the application being put on hold or cancelled.
Providing false information to Capital Region Housing may result in the application being cancelled or
no longer being eligible for services.
If I/we are being considered for an available unit, Capital Region Housing may need additional
information to make sure all my/our information is up to date and that my/our household still qualifies.
It is my/our responsibility to keep Capital Region Housing updated on any changes to my/our
circumstances or the information provided in this application.
Application must be signed by the Applicant and members of the household over 18 years of age.
Print Name Signature
Date
(MM/DD/YYYY)
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