Application for housing

For Use With All Hawaii Housing Programs

This is an application for housing at:
Project:
Kulana Hale Senior Community
Address:
1551 S. Beretania St.
Honolulu, Hawaii 96826

Applications are placed in order of date and time received. An applicant may be interviewed only after the receipt of this tenant application. Every question must be answered. Do NOT leave blanks. Use N/A when applicable.

A. General Information
Do you:
$
If owned, do you receive monthly rental income from property?
Check utilities paid by you:
$
Bedroom size requested:
Are you currently receiving any type of rental assistance?
B. Household composition
NameRelationship
to head		Birth
date		Age
(optional)		SS#
(last 4 digits)		Student
Y/N
1. Have there been any changes in household composition in the last twelve months?
2. Do you anticipate any changes in household composition in the next twelve months?
3. Is there someone not listed above who would normally be living with the household?
4. Are you living with anyone now who will not be moving into this unit with you?
5. Will all of the persons in the household be or have been full-time students during five calendar months of this year or plan to be in the next calendar year at an educational institution (other than a correspondence school) with regular faculty and students?

If yes answer the following questions (6-10):

6. Are any full-time student(s) married and filing a joint tax return?
7. Are any student(s) enrolled in a job-training program receiving assistance under the Job Training Partnership Act?
8. Are any full-time student(s) a TANF or a title IV recipient?
9. Are any full-time student(s) a single parent living with his/her child(ren) who is not a dependent on another’s tax return and whose children are not dependents of anyone other than a parent?
10. Is any student a person who was previously under the care and placement of a foster care program (under Part B or E of Title IV of the Social Security Act)?