READY-TO-RENT LIST

PRELIMINARY RENTAL APPLICATION

This application may be used to submit a new application or update a previously submitted application.

EQUAL HOUSING OPPORTUNITY

Management will provide help in reviewing this document if necessary. Paper copies are available upon request. Persons with disabilities may ask for this application in large print type or other alternate formats.

Note: Please fill in all sections completely. Please contact Housing Nantucket if you need help completing this application.

Phone Number: (508) 228-4422

Email: info@housingnantucket.org

Applicant Information

What is your full name?*

What is your email address?*

What is your phone number?*

Phone

What is your race?*

(Optional Section: Information will be used for fair housing programs only, as required by State and Federal Laws.)

Select

What is your current home address?*

Are you a local resident to Nantucket?*

To be a local resident you must meet one of the following criteria:

Currently residing year-round on Nantucket
Currently employed or recently hired by an employer with a physical location on Nantucket
Children are enrolled in a Nantucket-based school

Select

How many years have you lived at this address?*

Please include an estimate with a decimal. For example, two and a half years would be 2.5 years.

What is your present rental cost per month?*

Are you including utilities?*

Select

What are your reasons for moving?*

How did you hear about Housing Nantucket and this opportunity?*

Household Members

What is your household's total annual income?*

Include all sources of income your household receives: W2 income, self employment, seasonal work, unemployment, alimony, investment income, etc.

Reported income should match line 9 of your 1040.

Is special accommodation required?*

Does any member of the household have any accessibility or reasonable accommodation requests or changes in a unit or development or alternate ways we need to communicate with you?

If yes, please explain.

How many people are in your household?*

Every household member must have an SSN or ITIN, and must provide documentation of filing on current U.S. tax returns.

Select or enter value

Household Member #1

To assist our application processing:

Please add your information first.

Do you have a Social Security Number?*

Select

What is your age range?*

Select

What is your gender?*

Select

Are you a full time student?*

Select

Household Member #2

To assist our application processing:

If you have a partner, please us their information here.

What is their full name?*

What is their relation to you?*

Select or enter value

Do they have a Social Security Number?*

Select

What is their age range?*

Select

What is their gender?*

Select

Are they a full time student?*

Select

Household Member #3

To assist our application processing:

Please add information for other relatives or household members before children.

What is their full name?*

What is their relation to you?*

Select

Do they have a Social Security Number?*

Select

What is their age range?*

Select

What is their gender?*

Select

Are they a full time student?*

Select

Household Member #4

What is their full name?*

What is their relation to you?*

Select

Do they have a Social Security Number?*

Select

What is their age range?*

Select

What is their gender?*

Select

Are they a full time student?*

Select

Household Member #5

What is their full name?*

What is their relation to you?*

Select

Do they have a Social Security Number?*

Select

What is their age range?*

Select

What is their gender?*

Select

Are they a full time student?*

Select or enter value

Household Member #6

What is their full name?*

What is their relation to you?*

Select

Do they have a Social Security Number?*

Select

What is their age range?*

Select

What is their gender?*

Select

Are they a full time student?*

Select

Employers

How many employers does your household have?*

Please include full time, part time, seasonal, and gig employers for all members of your household.

If you are self employed, include your company.

Select

Employer #1: What is the Employer's name?*

Employer #1: Which household member has this employer?*

Please enter their full name as it appears on this application.

Employer #1: What is the employer's address?*

Employer #1: What is the employer's phone number?*

Employer #1: What is the household member's job title?*

Employer #1: How many years employed by this employer?*

Please include a decimal for partial years. For example, two and a half years is 2.5 years.

Employer #1: How much is made annually from this employer?*

Do your best to estimate annual payment if paid weekly, monthly, etc.

Employer #2: What is the Employer's name?*

Employer #2: Which household member has this employer?*

Please enter their full name as it appears on this application.

Employer #2: What is the employer's address?*

Employer #2: What is the employer's phone number?*

Employer #2: What is the household member's role?*

Employer #2: How many years employed by this employer?*

Please include a decimal for partial years. For example, two and a half years is 2.5 years.

Employer #2: How much is made annually from this employer?*

Do your best to estimate annual payment if paid weekly, monthly, etc.

Employer #3: What is the employer's name?*

Employer #3: Which household member has this employer?*

Please enter their full name as it appears on this application.

Employer #3: What is the employer's address?*

Employer #3: What is the employer's phone number?*

Employer #3: What is the household member's role?*

Employer #3: How many years employed by this employer?*

Please include a decimal for partial years. For example, two and a half years is 2.5 years.

Employer #3: How much is made annually from this employer?*

Do your best to estimate annual payment if paid weekly, monthly, etc.

Employer #4: What is the employer's name?*

Employer #4: Which household member has this employer?*

Please enter their full name as it appears on this application.

Employer #4: What is the employer's address?*

Employer #4: What is the employer's phone number?*

Employer #4: What is the household member's role?*

Employer #4: How many years employed by this employer?*

Please include a decimal for partial years. For example, two and a half years is 2.5 years.

Employer #4: How much is made annually from this employer?*

Do your best to estimate annual payment if paid weekly, monthly, etc.

Assets

Please list all assets owned by members of the household.

What type of assets does the household own?*

Please include all assets owned by every household member.

Select all that apply.

Select

Checking / Savings Accounts: What are the bank name(s)?*

Checking / Savings Accounts: What are the balance(s)?*

Investment Accounts: What are the account name(s)?*

Investment Accounts: What are the balance(s)?*

Retirement Accounts: What are the type and names of any retirement accounts?*

Retirement Accounts: What are the balance(s)?*

Venmo / Pay Apps: What are the account name(s)?*

Venmo / Pay Apps: What are the balance(s)?*

Trust Fund: What are the fund name(s)?*

Trust Fund: What is the value & distributions?*

Other Accounts: What are the account name(s)?*

Other Accounts: What are the balance(s)?*

Real Estate

Do you or anyone on this application own residential or commercial property?*

This includes property anywhere in the world.

Select

What are the property address(es)?*

What is the market value?*

For partially owned properties, include the market value of your ownership stake. Please combine the market value of all properties, if there are multiple.

What is the outstanding mortgage or other loan balance?*

For partially owned properties, include the mortgage value of your ownership stake.

Are you, or anyone on this application, entitled to receive any amount of money from the sale of any property?*

Please consider current entitlements or through an upcoming court settlement.

Select or enter value

Real Estate: What are the property address(es)?*

What is the market value?*

For partially owned properties, include the market value of your ownership stake. Please combine the market value of all property stakes, if there are multiple.

Additional Income

Which additional sources of income does the household have?*

Please include all members of the household. Do not include tax withholding, provide the gross income.

Select all that apply.

Select

Which household member(s) collect dividend / interest income?*

What is the annual dividend / interest income?*

Which household member(s) collect unemployment?*

What is the annual unemployment income?*

Which household member(s) collect child support / alimony?*

What is the annual child support / alimony income?*

Which household member(s) collect social services income?*

What is the annual social services income?*

Which household member(s) collect other income?*

What is the annual income from other sources?*

Signature*

We hereby certify that the information furnished on this application is true and complete, to the best of my/our knowledge and belief. Inquiries may be made to verify the statements herein. All information is regarded as confidential in nature, and a consumer credit report and a Criminal Offenders Record Information (CORI) report may also be requested. I/We certify that I/we understand that false statements or information are punishable applicable under State or Federal Law.

I/We hereby certify that we have received a notice from the management agent describing the right to reasonable accommodations for persons with disabilities.

Click the below check box to sign under the pains and penalties of perjury.

Please enter the signers full legal name.*

NHA Properties Inc. will not discriminate on the basis of race, color, creed, religion, national or ethnic origin, citizenship, ancestry, class, sex, sexual orientation, familial status, disability, military/veteran status, source of income, age, or other basis prohibited by local, state or federal law in any aspect of tenant selection or matters related to continued occupancy.

Incomplete forms will not be processed.

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