Application Form

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Please feel free to fill out this preliminary application to apply for an apartment at any one of our three Grace Apartments locations.

Once your application is submitted, we will review your application and let you know of availability of apartments in your area of choice.

Please choose what location you are interested in

Mauston

Wisconsin Rapids

Poy Sippi

Applicant #1
Name		SSN		Date of Birth
Applicant #2
Name		SSN		Date of Birth
Present Address				Phone

Family Composition List each family member who will live in the dwelling. Identify full-time students (FTS).
	Name	FTS	SSN	D.O.B.	Relationship to Family Head	Age	Sex
1					Choose One Spouse Child Grandchild Other		M F
2					Choose One Spouse Child Grandchild Other		M F
3					Choose One Spouse Child Grandchild Other		M F
4					Choose One Spouse Child Grandchild Other		M F
5					Choose One Spouse Child Grandchild Other		M F
6					Choose One Spouse Child Grandchild Other		M F

Income List all sources of income including full / and or part-time employment, welfare, Social Security, SSI, pension,disability support, unemployment, educational loans, scholarships, grants, AFDC and their rates.
	Source, Rate (i.e. weekly, monthly, yearly, etc.) and Type of income	Current $	Anticipated $
1
2
3
4
5
6

Assets Assets means the value of equity in real property, savings accounts, checking accounts, stocks, bonds, otherforms of capital investments, and Insurance that pays dividends. List "%" of interest per each account.
Account #	Names, Address, & Phone# of Financial Inst./Banks where assets are held.	%	Type of Account	Balance
			Choose Checking CD Savings Stock Bond
			Choose Checking CD Savings Stock Bond
			Choose Checking CD Savings Stock Bond
			Choose Checking CD Savings Stock Bond
			Choose Checking CD Savings Stock Bond
			Choose Checking CD Savings Stock Bond

Cash on hand, Stocks, Bonds, Real Estate presently owned, Real Estate previously owned value: $
Explain in detail:

Allowances List Names and Phone numbers of agencies: Include medical expenses not covered by insurance; i,e,prescription costs, medical care, hospital insurance, childcare cost for care of minors under the age of 13, or for the care ofdisabled persons when such care enables a family member to be gainfully employed. (This should include the name of person whosits, their price charged per hour, etc.)
Federal Preferences - Is present housing substandard?	Yes No
If Yes, explain in detail:
Do you qualify for displacement status?	Yes No
If Yes, explain in detail:
Do you pay more than 50% of your income for rent?	Yes No

References Last two previous landlords
Name	Present Address	Phone
Credit References List two credit references we can contact to verify your credit.
Name	Present Address	Phone
In case of Emergency Notify
Name	Address	Phone
Relationship

Authorization Code
Enter Above Code