For AFP Official Use Only

ALLIANCE FOR PROGRESS Online Version

1070 Ogden Avenue, STE CS-2 ● Bronx, NY 10452
T.: 718-992-6448 ● Website: www.allianceprogress.org Date
AFP
Application #
APARTMENT APPLICATION
Name:
First Middle Last

Current Address:
Number & Street

County/City State Zip code

Telephone: ( ) Current Rent: $

Area code Number Monthly Rent
Current Landlord:
Name or Company

Number & Street

County/City State Zip code

How long have you been living at this address?

Years Months
Reason(s) for Leaving:

Previous Address:
Number & Street

County/City State Zip code

How many BEDROOMS are you seeking?

Please provide the following information about your household members who will be living in the unit for
which you are applying.
Household Member Name Relationship Sex Date of Birth Social Security

SELF  M W

 M W

 M W

 M W

 M W
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 Do you have Section 8 Certificate/Voucher?  Yes  No

Are you or any person in the household currently enlisted in the

Military service?  Yes  No

Please list all full and/or part-time employment for all household members including applicant. In addition,
please disclose self-employment earnings, if any.
Length of Gross
Household Member Name & Address of Employer Employment Earnings

Please list any BANK references:

Bank Name Address Account Number

Has applicant, spouse, co-applicant or other potential occupants ever been arrested or indicted
for, or convicted of a felony or a misdemeanor?  Yes  No
If yes, please explain: ____________________________________________________________
Has applicant, spouse, co-applicant or other potential occupants ever been a party to a
landlord/tenant legal action, such as dispossess for non-payment, late payment, eviction,
possession, property damage, etc?  Yes  No
If yes, please explain: ____________________________________________________________
Have any judgments been entered against applicant, spouse, co-applicant or other potential
occupants?  Yes  No
If yes, please explain: ____________________________________________________________

How did you hear about Alliance For Progress?

 Newspaper  Our Website  Other: __________________
 Local Organization or Church  Friend or family Please specify
 Community Event  Agency Referral

PLEASE NOTE:
● NO DOGS ● NO CATS OR OTHER PETS PERM ITTED ● NO W ASHING M ACHINES ●
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 PLEASE NOTE:
● NO PAYMENT OR FEE SHOULD BE GIVEN TO ANYONE IN CONNECTION WITH
THE PREPARATION, FILING OR PROCESSING OF THIS APPLICATION FOR
HOUSING. ● EMPLOYEES AND THE FAMILY MEMBERS OF
ALLIANCE FOR PROGRESS AND ITS SUBSIDARIARES/AFFILIATES ARE
INELIGIBLE. ● ONLY ORIGINAL APPLICATIONS ARE ACCEPTED – NO COPIES. ●
Racial Group Identification
(Provided by the applicant on a voluntary basis. Used for statistical purposes only.)

THIS INFORMATION WILL NOT AFFECT THE PROCESSING OF THIS APPLICATION

Please check one group which identifies the head of household.

 White: Non-Hispanic Origin  American Indian or Alaskan Native
 Black: Non-Hispanic Origin  Asian or Pacific Islander
 Hispanic  Other: _____________________
Please specify

Fair Credit Reporting: I/ We agree that the owner/agent may obtain or use a consumer reporting
agency or other investigative agencies in connection with this application to lease an apartment.
Subsequent similar reports may be requested or utilized in connection with an update, renewal or
extension of this application or your lease and for any other legitimate business purpose. Upon
request, you will be informed whether a consumer report or an investigative consumer reports or
investigative reports pertaining to you after you vacate the apartment in order to collect amounts due
or for other legitimate business purposes.

I/We hereby certify that the statements made in this application have been examined by me/us and
are true, correct and complete to the best of my/our knowledge, I/We have no objection to the
inquiries to be made in the future for the purpose of verifying the facts herein stated or determining
the qualification of my/our application. I/We understand that the filing of this application in no way
obligates owner/agent to reserve or lease an apartment to me.
Furthermore, I/We certify that neither I/We nor any member of my/our immediate family are
employed by Alliance For Progress or its subsidiaries/affiliates. WARNING: Misleading willful
false statements, misrepresentations, or incomplete information in this application will be grounds for
rejection of this application in accordance with section 1001 of title 18 of the U.S. Code.

Signature of Applicant Date

Signature of Applicant Date

You have certain rights under Federal, State & local law in respect to your consumer report. In evaluating your
application, a consumer reporting agency listed below may provide us with information.
Credit Bureaus:
● Experian, ATTN: NCAC, PO BOX 2002, Allen, TX, 75013 (888) 397-3742
● Trans Union, Consumer Disclosure Center, PO BOX 1000, Chester, PA 19022 (800) 888-4213
● Equifax, PO BOX 740241, Atlanta, GA 30374 (800) 685-1111
Civil Records:
● CoreLogic SafeRent, Consumer Relations, 7300 Westmore Rd STE 3, Rockville, MD, 20850 (888) 333-2413
Additionally, you have the right to obtain one free copy from www.annualcreditreport.com. You have the right to
dispute any inaccurate information in the report.

[3]
 APPLICATION REQUIREMENTS / REQUISITOS DE LA SOLICITUD
Please submit the following information with your
application:
 The most recent tax return
 Three (3) most recent bank statement
 A completed Rent Verification Request
 A completed Employment Income
Verification Request
 Picture ID for every adult
 Social Security cards for everyone on the
lease
 Birth Certificate and school letter for child
under 18 years of age
 A fifty dollar ($50) non-refundable money
order for each adult household member’s credit
check
If applicable, please bring a copy of:
 Four (4) recent pay stubs and most current
Wage and Tax statement (W-2 r 1099 Form)
 A letter of employment with gross salary and
start date
 A pension or annuity check
 Alimony income
 An award notification letter from Social
Security
 The budget letter from the Department of
Social Services
Por favor, traiga una copia de los siguiente con su
solicitud:
 La más reciente documentación de impuestos
 Los tres (3) más reciente estados de cuenta
bancario
 Una carta completada de verificación de
alquilamiento
 Una carta completada de verificación de empleo
y ingreso
 Una identificación, con foto, para cada adulto
 La acta de nacimiento y carta de escuela para
todo menor de 18 años de edad
 Tarjeta del seguro social para cada persona en
el contracto de apartamento
 Un giro postal de cincuenta dólares ($50) para
cada adulto en el hogar para la investigación de
crédito lo cual no es reembolsable
Por favor traiga una copia de lo que le aplique:
 Cuarto (4) talonarios más reciente y el más
reciente estado de ganancias y impuestos
(Formulario de W-2 o 1099)
 Una carta de empleo con salario anual y el día de
comienzo
 Una carta de la pensión o cuenta de retiro
 Una carta de manutención
 Una carta de la Administración de Seguro
Social
 Una carta de presupuesto del Departamento de
Servicios Sociales

THE STATUS OF AN APPLICATION WILL NOT BE GIVEN TO ANY APPLICANT!

¡LA ETAPA DE LA SOLICITUD NO SERÁ OTORGADA EN NINGÚN MOMENTO!
■ Since so many household need housing we will be unable to accommodate all who are
eligible. The filing of this application in no way guarantees you an apartment.
■ Mail one application per family by regular mail only; no oversize envelopes will be
accepted. Express, certified or registered mail will not be accepted.
■ If more than one application is received, all applications will be disqualified. All
completed applications should be return to address listed below:

Alliance For Progress

1070 Ogden Avenue, STE CS-2
Bronx, NY 10452

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 1070 Ogden Avenue, Suite CS – 2 Bronx, N.Y. 10452
AFP Tel.: (718) 992 – 6448 Fax: (718) 992 – 7782
Web Site: www.allianceprogress.org

Employment Income Verification

Employer’s Name: ___________________________________________________

Employer’s Address: _________________________________________________

Applicant/ Tenant Name: _______________________________ SSN: _____________________

Applicant/ Tenant Address: ______________________________________________________

The applicant/ resident named above has authorized the release of information. This information
will be used solely the purpose of determining eligibility. If you have any questions please feel
free to contact our office. Thank you for your cooperation.
Alliance For Progress ▪ 1070 Ogden Avenue STE CS-2 ▪ Bronx, NY 10452 ▪ T.: 718-922-6448

Applicant Authorization
I hereby authorize the release of the information requested on this verification form.

Date Applicant’s Signature

TO BE COMPLETED BY THE EMPLOYER

Date of Hire: _____/ _____/ _____ Occupation/ Title: __________________________

Terminated:  Y  N Reason: _________________________________________________

 Salary $ ___________/ year

Base Pay Rate:  Per Hr _________  Per Week __________  Per Month _________

Hourly Rate $ ____________ Avg. Hrs per week ____________

Overtime Rate $_______________ Avg. Hrs per week ________

Avg. total weeks compensated per year: $_____________

Does the employee receive any other compensation not included above (specify for commissions,
bonuses, tips, etc.)? ________________________ Amt $_____________ per _____________

(Please turn over)

COMMITMENT TO THE COMMUNITY

Is pay received for vacation? ________ Number of days per year _______

Total gross earnings anticipated for the next twelve months (including anticipated changes in rate
of pay, tips, overtime, bonuses, commissions, etc.): $ ____________________

I certify that the above information is true and accurate.

Company Name _________________________________ Date:______________________

________________________________ ____________________________________
Signature Title

PENALTIES FOR MISUSING THIS CONSENT

Title 18, Section 1001 of the U.S. Code states, that a person is guilty of a felony for knowingly
and willingly making false or fraudulent statements to any department of the United States
Government. HUD and any owner (or any employee of HUD or the owner) may be subject to
penalties for unauthorized disclosures or improper uses of information collected based on the
consent form. Use of the information collected based on this verification form is restricted to the
purposes cited above. Any person who knowingly or willingly requests, obtains or disclosures
any information under false pretenses concerning an applicant or participant, may be subject to a
misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent
disclosure of information may bring civil action for damages and seek other relief, as may be
appropriate, against the officer or an employee of HUD or the owner responsible for the
unauthorized disclosure or improper use. Penalty provisions for misusing social security
numbers are contained in the Social Security Act at 208 (a), (6), (7) and (8). Violation of these
provisions are cited as violations of 42 U.S.C Section 408 (a), (6), (7) and (8).
 1070 Ogden Avenue, Suite CS – 2 Bronx, N.Y. 10452
AFP Tel.: (718) 992 – 6448 Fax: (718) 992 – 7782
Web Site: www.allianceprogress.org

Rent Verification Request

Applicant’s Name: ______________________________________

Current Address: _______________________________________

_______________________________________

Your signature below authorizes the release of any information verifying

your rental history to Alliance For Progress, its subsidiaries and affiliates.

Applicant’s Signature:

Dear Landlord:

The above named person(s) has applied for a new apartment. Please
complete the following information regarding his/her past rental payment
record and forward said form to our office.

Thank you, in advance, for your cooperation in this matter.

Monthly Rent:

Length of time renting:

 Excellent  Average  Poor
Rent payment experience:

Name of Landlord/ Mgmt:

Title:

Signature:

Telephone Number:

COMMITMENT TO THE COMMUNITY