Fair & affordable rental housing application

Initial Application for

Alexan Harrison

3 Westchester Park Dr, West Harrison NY 10604

(Before applying, be certain you conform to all guidelines)

Application Deadline:

Must be submitted online or hand-delivered by this time, or postmarked by this date if mailed.

(applications after deadline will be placed on waitlist)

Lottery Date: September 26, 2024 11:00 AM

Submit Initial Application Online, or Print and Mail or Hand Deliver to:

Attn: Affirmative Marketing
Westchester Residential Opportunities, Inc.
470 Mamaroneck Avenue, Suite 410
White Plains, New York 10605

Do not apply more than once. If your household applies more than once, all of your applications may be disqualified.

Please Note: This is an initial application. It does not include all the information and documentation that will be required to qualify you to rent an apartment or purchase a home, as applicable. To income qualify, you will need to complete additional information requests regarding your household's income and assets, and provide documentation to support that income and assets.

Please direct any questions to us at affordable@wroinc.org or 914-428-4519.

1. Applicant Information

Full Name *

First Name
Middle Name
Last Name
Suffix
Identification *

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Physical Address *

Address Line 1

City
State
Zip Code
County
Mailing Address (if different)

Address Line 1

City
State
Zip Code
County
Email * & Phone Number(s)

Primary Email Address
Best Phone Number
Other Phone Number
Gross Annual Income *

Applicant's gross annual income (include total of income from all sources)
What size(s) apartment unit are you applying for? *

Note: Check all that apply.

1. Applicant Information (contd.)

Total number of Household Members *
Are all household members Full-Time Students?
Do you have a live-in aide or assistant?
Do you anticipate any additions to the household in the next 12 months? *

If YES, explain:
Total Gross Annual Household Income *

Include all sources of income, e.g., wages, social security, pension, child support, self-employment income, monthly/annual distributions, alimony, etc.
Household Accounts
Account Type Account # Value ($) Financial Institution
Note: Only specify the last 4 digits of your account number in the account number column.

1. Applicant Information (contd.)

Total Household Assets *

Include total dollar amount
Does anyone in the Household currently own real estate? *

If YES, what is the value of the real estate in dollars?
Current monthly rent and payments *

Include any housing or utility payments, like amenity fees, electric, gas, etc.
Do you have a Housing Choice Voucher or other rental subsidy?







This information is used to determine what eligibility levels apply to your application. New York State Human Rights Law prohibits the discrimination in housing based on lawful source of income, including whether you have a Section 8 voucher.

If Other, please specify:

If you have a housing subsidy or voucher, what office administers that subsidy/voucher?

2. Co-Applicant Information

Full Name

First Name
Middle Name
Last Name
Suffix
Identification *

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Address

Address Line 1

City
State
Zip Code
County
Email & Phone Number(s)

Primary Email Address
Best Phone Number
Other Phone Number
Gross Annual Income

Co-Applicant's gross annual income (include total of income from all sources)

3. List all persons who live with you

Note: In addition to the Applicant and Co-Applicant

Household Member #1
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #2
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #3
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #4
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #5
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #6
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #7
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #8
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #9
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

3. List all persons who live with you (contd.)

Note: In addition to the Applicant and Co-Applicant

Household Member #10
Full Name

First Name
Middle Name
Last Name
Suffix
Identification

Date of Birth 		 
Last 4 of SSN/ITIN 		 
ID Type/Number 		 
ID Issue Date
Relationship to Applicant







Note: Please select only one






Occupation
Full-Time Student?
Gross Annual Income

Household member's gross annual income (include total of income from all sources)

4. Statistical Information

Responding to this Section is OPTIONAL. The following demographic information is for statistical purposes only, so that we, Westchester County, New York State and the US Department of Housing and Urban Development may determine the degree to which its programs are utilized by people of different racial & ethnic backgrounds. Provide information for the Head of Household only.

Racial Identity












Please select only one from this group for Head of Household only.

Ethnicity




Please select only one from this group for Head of Household only.

5. Accessibility

We do not have accessibility information available at this time.

6. Pet Policy

This building allows pets, subject to the restrictions in its pets policy. Service and assistance animals (like emotional support animals) are allowed and are not considered pets.

7. Declaration(s) and Signature(s)

I declare that the statements contained in this application are true and complete to the best of my knowledge. I understand that this is an initial application, and that I will be required to provide additional information and documentation on my income and assets if/when the property manager considers my application. WARNING: Willful false statements or misrepresentations are a criminal offense.

I (We) authorize my (our) consent to have management verify the information in this application for the purpose of providing my (our) eligibility for occupancy. I will provide all necessary information including source names, addresses, phone numbers, and account numbers where applicable and any other information required for expediting this process. I (We) understand that my (our) occupancy is contingent on meeting management's resident selection criteria and requirements.

Primary Applicant *
Co-Applicant

Signature
Date 		 
Signature
Date 		 

8. How did you hear about this Development?

Check all that apply and list details in the Comments box below:











Comments:

Notes
  1. Only one (1) application per household. If your name appears on more than one application, you may be disqualified, and the application may not be considered.
  2. Applications must be signed in all requested places.
  3. Applications must be returned either electronically, by mail or hand delivered.
  4. No payment should be given to anyone in connection with the preparation or filing of this application. If/when your application is considered by the property manager, you may be required to reimburse the cost of the credit and/or background checks for your households' members, to the extent permitted by New York law.
  5. This is an initial application. It does not include all the information and documentation that will be required to qualify if/when the property manager considers your application. To income qualify, you will need to complete additional information requests regarding your household's income and assets and provide documentation to support that income and assets.
Please direct any questions to us at affordable@wroinc.org or 914-428-4519.