The Gardens at St. Anthony Housing Application

The Application for Admission to St. Anthony’s can be completed by filling out the form below or by downloading the Application (pdf), filling it out in its entirety and either:

Questions? Please contact us at 1-888-477-4663 (TTY: 711)

    Housing Application

    Are you currently working with the Homeless Housing Alliance, Rescue Mission, United Way or other local social service agency?(required)


     

    Daytime Phone Number(include area code): (required)

    Evening Phone Number (include area code): (required)

    Best Way to Contact You:




    Other Contact Phone Number (include area code):



    How long did you reside there? (required)

    Are you established with a Health Home?


     


    Applicant Case Manager Phone Number (include area code):
    Are you a current resident of a Nursing Home?


     
    What was your residence prior to nursing home placement?



    Are you a current resident of a shelter?


    Present Landlord Phone Number (include area code): (required)


    List all persons who live in the apartment.

    List Head of Household first:

    Income and Asset Information:

    For every type of Income, list gross monthly amounts:

    Wages

    Unemployment

    Social Security

    Public Assistance

    Pension/Annuity

    Disability/SSI

    Child Support/Alimony

    Sections 8 Assistance

    Other

    For every type of Asset, list gross monthly amounts:

    Savings Account

    Checking Account(s)

    Certificate of Deposits (CD's)

    Stocks & Bonds

    Real Property

    Cash (Safe deposit box, etc.)

    Any Other:

    Preferred Unit Size(s) (please note that household size determines unit size eligibility)

    Does anyone in your household identify as a person with a disability?

    Will the disability require any special accommodations to your apartment or lease?

    Veterans Admission Preference - If head or co-head is an honorably discharged veteran of the US Armed Services or such veteran’s spouse, who served on active duty and resides in NYS, check yes and attach form DD-214 for determination of eligibility for admission preference.

    Have you or any member of the household ever been convicted of a felony?

    Are any members of the household subject to a lifetime sex offender registration requirement in any state?

    I am attaching a) six (6) consecutive months of recent rental payment history; or b) receipt of subsidies that pay full rental amount.

    I am aware of my right to the following (attached below): HUD Notice of Occupancy Rights Under the Violence Against Women Act and HCR New Anti-Discrimination Guidance Affecting People with Criminal Histories. (required)

    I am aware of my right to request a reasonable accommodation or modification as an individual with disabilities under the Americans with Disabilities Act. (required)

    Your signature(s) below serves as written permission for Gardens at St. Anthony’s to obtain a Criminal Background check. The applicant(s) affirms that all information in this application is true and complete. The applicant(s) also understands that a personal interview must be held, and assets and income verified and approved. All information received is confidential. This application creates no obligation for the Landlord or applicant. After the application process is approved, a security deposit must be made and a lease agreement signed by both applicants. If accepted, Applicant(s) certify this apartment will be their sole residence. The undersigned makes the foregoing representation knowing that if any of such proves false, Gardens at St. Anthony’s may cancel and annul any lease given in reliance upon such information.


    If a portion or all of the application is completed by someone other than the applicant, the following statement must be completed.

    I/We have completed all or part of this application at the request of the applicant(s):