Fillable Pre-Application Interested Parties Waiting List

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Pre-Application Interested Parties Waiting List

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The Pre-Application Interested Parties Waiting List form is 1 page long and contains:

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  • 16 check-boxes
  • 14 other fields

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File type: PDF

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Interested Parties Waiting List
Pre-Application
Applicants must provide complete identifying information below to be placed on the
Interested Parties housing waiting list. Incomplete pre-applications will not be added to the waiting
list. Please see the Building Criteria sheet for each individual building for additional information on
eligibility and screening requirements. Please note that this is NOT a pre-application for placement on a subsidized
housing wait list.
Applicant Information
La
stName
FirstName
M.I.
Ma
iling
Address
AptNo.
Zip
Code
(
________)___________________ May we... Text you? Leave a Msg?
EmĂŝů
Ci
t
y
Phone Number
Sta
t
e
Monthly gross income from all sources except food stamps
$ _________________ͺͺͺ___
I require an accessible unit (subject to availability)
If yes, explain briefly: ______________________________________________
ͺͺͺͺͺͺͺͺͺ_
____
____
Have you been charged with or convicted of any crimes?
Yes
Applicant–PleaseReadCarefullyBeforeSigning
ApplicantSignature (or typed name if submitted online) Date
CentralCityConcernnotifiesInterested Parties Waiting List applicants by phone or email w
hentheynear
thetopofa building's wait list.Wait list applicantsmustrespondby phone or email to the CCC Housing Officewithin
3 business days toavoidbeingremovedfromthe wait list for that building.Itiswait listapplicant’s responsibility
tonotifythe CCC Housing Office ofphone, email or mailingaddresschanges usingtheAddressChange form for
thisbuilding.
IcertifythefactsonthisPre‐Applicationaretrueandcomplete.Providingfalseinformationwillresultin
removalfrom all wait list being applied for through this pre-application.
Office Use Only! ID #: ______________ Initials: ______________ Date/Time Rcv'd: _______________/__________ Unit Size: ____________
No
Ankeny Square (204 SW 8th Ave.)
Hotel Alder (415 SW Alder)
Estate Building (225 NW Couch)
ADFC SRO (1 occupant only)
Henry Building (309 SW 4th Ave.)
Hotel Alder (415 SW Alder)
Biltmore Hotel (310 NW 6th Ave.)
Butte (610 NW Davis)
Katherine Gray (1115 SW 11th Ave.)
Sally McCracken (532 NW Everett)
ADFC Efficiency Studio (1 occupant only)
ADFC Studio (1-2 occupants)
Non-ADFC SRO (1 occupant only)
Non-ADFC Studio (1-2 occupants)
Ankeny Square (204 SW 8th Ave.)
Estate Building (225 NW Couch)
Richard L. Harris (225 NW Couch)
ADFC- Alcohol and Drug-Free Community, must be in a
program of recovery and be clean and sober for at least
90 days at time of intake.
SRO- Single Room Occupancy, residents share
common area, bathroom and kitchen.
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Pre-Application Interested Parties Waiting List

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Completed 1 March 2022

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