You are on page 1of 9

Blackland Affordable Housing Program

~Information Sheet~
The Blackland Affordable Housing Program, a project of the Blackland Community
Development Corporation (BCDC), provides affordable housing to low-income families with
children under the age of 18 and up to the age of 21 if attending school. Limited affordable
housing services are available to individual adults with disabilities. Robert Shaw Village
provides affordable housing to senior citizens (62 years old and over with no disability, 60 and
over with a disability).
The following regulations apply to both programs:
Eligibility Requirements
You must pass the following eligibility criteria to be accepted into the program:
• Be at or below 60% of the City of Austin’s Median Family Income (MFI). The MFI is
calculated and updated annually by HUD and is available for review upon request. For
certain homes the maximum income is 50% MFI.
• Have a gross monthly household income of at least 2.5 times the monthly rent; 2 times
for Robert Shaw Village
• Pass a criminal background check (no assaults or criminal sexual behavior)
• Prove one year of verifiable good rental and employment history
Application Process
Please speak with Pam Johnson, Blackland’s case manager, to determine your eligibility. If you
qualify, you will be asked to speak with Donna Henderson, Blackland’s property manager, to
complete an application and provide the necessary documentation. Applications are processed on
a first-come-first-serve basis.
The following documents must be provided for your application to be complete and in the queue:
 Picture I.D. for all household members over the age of 18.
 Social Security cards for all household members.
 Birth certificates for all household members.
 Proof of verifiable income for the past two months
 Income tax return for the past year
Applications are good for six months. After that you will be required to re-apply.
APPLYING DOES NOT GUARANTEE YOUR ENTRANCE IN THE PROGRAM, so please
continue to pursue other housing options as well.

Blackland Community Development Corporation provides equal and fair housing opportunities.

BCDC does not discriminate on the basis of race, religion, sex, disability, national origin, marital or
student status, or sexual preference.

2

BLACKLAND COMMUNITY DEVELOPMENT CORPORATION
AFFORDABLE HOUSING PROGRAM
RENTAL APPLICATION
Blackland Community Development Corporation provides equal and fair housing opportunities. We do
not discriminate against anyone on the basis of race, color, religion, sex, handicap, national origin,
marital or student status, age or sexual preference. Any information we request pertaining to ethnicity or
race is to ensure compliance with Fair Housing Standards. Providing this information for this
application is optional; however, should you be accepted into our housing, you will be required to provide
it at that time. Please initial here to show that you have read and understood this:
(Each household member other than spouses over 18 years old must submit a separate application)

Name:

Spouse’s Name:

Present Street Address:
City, State, ZIP:
Telephone: (home):

(cell):

Social Security No: ___________________

(work):
Driver’s License No.:

Spouse’s Social Security No.: ________________ Spouse’s Driver’s License No.:
Date of Birth: _________________

Spouse’s Date of Birth: ______________________

List Other Household Members:
1.

_________________________ D.O.B._____________ Relationship: ____________

2.

_________________________ D.O.B.____________ Relationship: _____________

3.

_________________________ D.O.B.____________ Relationship: _____________

4.

_________________________ D.O.B._____________ Relationship: _____________

5.

_________________________ D.O.B._____________ Relationship: _____________

6.

_________________________ D.O.B._____________ Relationship: _____________

3

RENTAL HISTORY

Present Landlord’s Address: ____________________________________________
Present Landlord’s Phone No.: _____________ Amount of Monthly Rent: _________
Date Moved-In: ____________________
Reason for Leaving:
___________________________________________________________________________

Previous Home Address: ________________________________________
City, State, and Zip Code: _______________________________________
Name of Previous Landlord: _____________________________________
Previous Landlord’s Address: ____________________________________
Previous Landlord’s Phone No.: ______________ Amount of Monthly Rent: _________
Date Moved-In: _____________________ Date Moved-Out: ______________________
___________________________________________________________________________
Previous Home Address: ______________________________________
City, State, and Zip Code: _____________________________________
Previous Landlord’s Name: ___________________________________
Previous Landlord’s Address: __________________________________
Previous Landlord’s Phone No.: ______________ Amount of Monthly Rent: ___________
Date Moved-In: _________________ Date Moved-Out: ___________________

4

EMPLOYMENT HISTORY
Present Employer: ______________________________________________
Address: ______________________________________________________
City, State, and Zip Code: _________________________________________
Phone No.: _________________________ Title: ______________________
Length of Employment: __________________ Monthly Income: _________________
Supervisor’s Name: ______________________ Phone No.: ______________________

Previous Employer: _____________________________________________________
Address: ______________________________________________________________
City, State, and Zip Code: _________________________________________________
Phone No.: __________________________ Title: ____________________________
Length of Employment: _____________________ Monthly Income: ____________
Supervisor’s Name: _________________________ Phone No.: __________________

Spouse’s Employer: _____________________________________________________
Address: ______________________________________________________________
City, State, and Zip Code: _________________________________________________
Phone No.: ___________________________ Title: ___________________________
Length of Employment: ___________________ Monthly Income: _______________
Supervisor’s Name: _______________________ Phone No.: ____________________

Other Income Sources: 1. ________________________ Monthly Income: ___________
2. ________________________ Monthly Income: ____________
3. ________________________ Monthly Income: ____________

5

VEHICLES
List all vehicles to be parked by you, your spouse, or any other occupants.
Make of vehicle: _____________________ Year: ____________ License No.: __________
Make of vehicle: _____________________ Year: ____________ License No.: __________
Make of vehicle: _____________________ Year: ____________ License No.: __________

EVICTION AND CRIMINAL BACKGOURND HISTORY
Have you or any other household member ever been evicted? ______ When? ____________
Have you or any other household member ever been convicted of a felony? ________
When? ______________
Explain:
___________________________________________________________________________
__________________________________________________________________________.

Other Assets
Have you owned a home in the last ten years? ___________ If “yes” list address.
___________________________________________

Do you own other real estate property? ____________ If “yes” list address
___________________________________________

Are you related to any Blackland Community Development Corporation Board Member?
______________ If “yes”, which Board Member are you related to and how are you related?
________________________________________________________________.

6

DEMOGRAPHIC INFORMATION
(Optional)
Ethnicity of Head of Household:
 Hispanic or Latino

 Not Hispanic or Latino

Race of Head of Household:




White
Asian
Native Hawaiian/Other Pacific Islander
Asian & White
American Indian/Alaskan Native &
Black/African American





Black/African American
American Indian/Alaskan Native
American Indian/Alaskan Native & White
Black/African American & White
Other Multi-Racial




Other
Vacant
Disability (Head of Household)
Female (Head of Household)

Type of Household (Head of Household):



Single, Non-Elderly
Elderly, 62 years +
Related/Single Parents
Related/Two Parents

I do not wish to provide this information at this time.

7

EMERGENCY INFORMATION
Please list the name, address and phone no. of a relative or friend to contact in case of emergency:
Name: _______________________________________________________________
Address: _____________________________________________________________
Phone No.: ____________________________ Relationship: __________________

PLEASE SIGN THE PERMISSION TO VERIFY AND RELEASE INFORMATION:
I give my permission and authorize the Blackland Community Development Corporation to verify the
information provided by me on this application regarding my income, employment, rental history,
criminal background, and credit history. I understand that my application will be rejected if I have
given false information. I also understand that my application will be rejected if I have failed to
answer any of the questions asked or provide any of the information requested on this application.
I give my permission to Blackland Community Development Corporation to make the
information in my files available to agencies or organizations that will be helping me.
Information will only be released to the appropriate staff of those agencies or organizations.
I understand that all information shared with agencies, organizations, and board members will be
kept confidential.
I also give my permission for other organizations or agencies to release information in my file to
Blackland Community Development Corporation for purposes of housing.
Applicant’s Signature: ____________________________ Date: ____________________

Spouse’s Signature: ______________________________ Date: ____________________

8

EMPLOYMENT VERFICATION

Blackland Community Development Corporation requests your assistance in verifying the
employment history of _______________________________.
Please provide the following information:
Dates worked
Position
Salary
I verify that the above information is correct.
Signature of Employer’s Representative:

Date

Permission by Applicant
I have given my permission to Blackland Community Development Corporation to verify my employment
history.
Signature of Applicant:

Date

9