schermerhorn application

8/11/2019 Schermerhorn Application

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THE SCHERMERHORNAPPLICATION

Photo Courtesy of David Sundberg/Esto for Ennead Architects LLP.

All information obtained is confidential and will be used for application review purposes only. SchermerhornHouse maintains a firm commitment to equal opportunity for all applicants. Schermerhorn House does not

discriminate based on race, sex, age, color, national origin, religion, sexual orientation, HIV status, ordisability.


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The SchermerhornSponsored by

The Actors Fund and Common Ground

Dear Applicant,

Thank you for contacting us. Per your request, an application is enclosed for an apartment at TheSchermerhorn.

The completed application must be sent to:

Common Ground - The SchermerhornCentral Intake Unit255 West 43rdStreetNew York, NY 10036

MAIL ONLY ONE APPLICATION PER INDIVIDUAL. YOU WILL BE DISQUALIFIED IF MORE THANONE APPLICATION PER INDIVIDUAL IS RECEIVED.

DO NOT GIVE BROKERS OR APPLICATION FEE TO ANYONE IN CONNECTION WITH THEOBTAINING, PREPARING OR FILING OF THIS APPLICATION FOR HOUSING.

The rent, household size, studio size and income distribution for these apartments is asfollows:

ApartmentsAvailable

Apartment Size Household Size Monthly Rent* Total Annual Income Range**Minimum-Maximum

100 Studio (266 sq. ft) 1 $635 $21,770-$36,120

* Includes Heat & Electric**Income eligibility is based on the Federal Low Income Housing Tax Credit guidelines. If your income is less than theminimum requirements listed above, you must have a rental subsidy (such as Section 8) to qualify. You will be required tosubmit proof of your rental subsidy (e.g. Rent Breakdown Letter or a copy of your voucher) at the time of interview.

Additional eligibility requirements: Assets must be evaluated in determining eligibility. If your assets are equal to or greater than

$250,000 you will not be eligible. Assets do not include personal property such as furniture,automobiles, and clothing.

Full-time students are not eligible for residency.

Pets are notallowed


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APPLICATION PROCESS

Applications for these apartments will be reviewed for eligibility and placed on a waitlist. If yourapplication is selected, we will notify you in writing and schedule an interview. Applicants will beasked to participate in at least two interviews. At the time of the interviews, the Intake Unit willreview your financial, credit, housing and employment histories. Please be aware that

acceptance for our housing is based on all of these criteria. AT NO TIME IN THEAPPLICATION PROCESS ARE YOU GUARANTEED AN APARTMENT UNTIL YOU HAVE SIGNEDA LEASE.

If you have any questions or experience difficulty completing the forms, please contact CommonGrounds Intake Office at 212-659-0878.

Sincerely,

Intake DepartmentSchermerhorn House

We Provide Housing in Compliance with Federal Fair Housing Laws


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1 The Schermerhorn Housing Applicaiton

Please complete all sections and sign the last page. All questions must be answeredif one does not apply,please draw a line through the question or write N/A. PLEASE PRINT.

CONTACT INFORMATION

1. NAMEFirst Middle Last

1a. Other names (maiden name, stage name, etc.

2. STREET ADDRESS APT. NO

3. CITY STATE ZIP -

4. HOME/CELL PHONE ( ) WORK PHONE ( )

5. BIRTHDATE _____/______/_______ Gender

6. EMAIL:

7. Are you a full time student? YES NONote:A Full-Time Student is one who attends school at least 5 months out of a year and has full-time student statusfor those 5 months.

Are you a part time student? YES NO

8. Do you require a special accommodation in your residence? YES NO(If yes, please check which disability applies):Mobility Impairment Visual Impairment Hearing ImpairmentPlease specify the accommodation required:______________________________________

9. (A) Are you an employee of the City of New York, the New York City Housing Development Corporation, theNew York City Economic Development Corporation, the New York City Housing Authority, or the New YorkCity Health and Hospitals Corporation? YES NO(If yes, please identify the agency or entity at which you are employed):Agency/Entity________________________________________________________________

(B) If you answered yes to Question 8A above, have you personally had any role or involvement in anyprocess, decisions, or approval regarding the housing development that is the subject of this application?

YES NO

NOTE: If you answered yes to Question 8A above, you may be required to submit a statement from your employerthat your application does not create a conflict of interest. If you answered yes to Question 8B above, you will berequired to submit a statement from your employer that your application does not create a conflict of interest. Suchstatement would not be required until later in the application process, after you have been selected through thelottery, when you will also be required to provide other documents to verify your income and eligibility.

10. Do you work in the performing arts and entertainment industry? YES NO (If yes, please describe youremployment): _____________________________________________________________________________

11. Are you a former resident of 20 Henry Street in Brooklyn? YES NO

HOUSING STATUS

12. Present landlord _______________________________Phone ( )____________________

13. Landlords address____________________________________________________________

14. Is your apartment leased directly to you? YES NO

15. Monthly rent $____________ 15a. Does your rent include electric? YES NO


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16. Avg. utility bill $___________

17. Is your rent subsidized? YES NO If yes, by whom? ________________________

18. How long have you lived at this address? ___________Years __________Months

19. PLEASE LIST YOUR LAST THREE RESIDENCES STARTING WITH THE MOST CURRENT:

PREVIOUS ADDRESS RENT AMTDATE OF

RESIDENCYWHY DID YOU

MOVE?

FROM

TO

FROM

TO

FROM

TO

20. What is your current annual income? _________________________________________

21. What was your total income from last years federal tax return? ___________________

EMPLOYMENT HISTORY

22. List all full- and/or part-time jobs worked during the last five years, includingself-employment and/or freelance income. List your current/most recent job first.

DATE EMPLOYER POSITION SALARY REASON FOR LEAVINGFROM

TO

FROM

TO

FROM

TO

FROM

TO


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OTHER CURRENT SOURCES OF INCOME

23. List other income that you currently receive, such as public assistance, Social Security, SupplementalSecurity Income, pension, disability, unemployment compensation, alimony, child support, Armed ForcesReserves, and/or grants.

TYPE OF INCOME AMOUNT

1) $ per

2) $ per

3) $ per

ASSETS

24. Complete each category as applicable, and attach statements for each account listed.

TYPE BANK NAME AMOUNT

CHECKING

DIRECT DEPOSIT ACCOUNTS

SAVINGS/PASSBOOK

MONEY MARKET/TRUSTS

CREDIT UNION SHARES

CDs

IRAs/ RETIREMENTACCOUNTS

STOCKS/BONDS

25. Do you own any real estate? YES NO If yes: What is the current market value? __________________

What is the value less any mortgage or lien? ___________________________________________________Do you receive any rent from tenant(s) living at this property? YES NOIf yes, how much? ________________

GENERAL QUESTIONAIRE

26. Have you ever been evicted? YES NO If yes, when? _______________________________________

Briefly explain circumstances: _______________________________________________________________

27. Have you ever filed for personal bankruptcy? YES NO If yes, when?__________________________

Briefly explain circumstances: _______________________________________________________________

28. Have you ever been convicted of a felony? YES NO If yes, when?____________________________Briefly explain circumstances: _______________________________________________________________

29. How did you hear about Schermerhorn House? _________________________________________________________________________________________________________________________________________


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30. Please list the names and phone numbers of two individuals, other than family members, whom we may calfor personal reference:

_____________________________________ _____________________________Name Phone Number

_____________________________________ _____________________________Name Phone Number

I hereby affirm that, to the best of my knowledge, the foregoing information is true, accurate and complete. Iunderstand that misleading or false statements, misrepresentations, or incomplete information in thisapplication will be grounds for rejection. I authorize The Schermerhorn Property Management to contact myagencies, offices, other groups or organizations to obtain any information or materials deemed necessary toprocess my application, including verifying my credit worthiness.

APPLICANTS SIGNATURE DATE


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COMMON GROUNDEMPLOYMENT VERIFICATION

I hereby authorize the release of the requested information, which will be kept confidential and used forprogram purposes only. Common Ground will call to verify this information.

_____________________________ _______________________________________

Applicants Name (printed) Applicants Signature

Dear Supervisor/HR Department Representative:The above-named person is an applicant to or participant in a federal housing program regulated by theInternal Revenue Service (IRS). The IRS program rules require verification of all income information. We askyour cooperation in providing the requested information. Thank you for your assistance.

Please complete and return to:Common Ground Fax: 212-302-8147Central Intake Unit Attention:255 West 43rdStreetNY, NY 10036

1. Employees Start Date: __________ Still Employed?_____If no, last date worked

2. Position/Job Title: ________________ Probability of Continued Employment

3. Year to Date Gross Earnings: $___________ through ___/___/___

4. Average Gross Pay: $ ___________per week / bi-weekly / monthly / annual (circle one)

5. Hourly Pay Rate: $__________ (if applicable) 6. Average Hours per Week:

7. Current Rate of Overtime (OT) Pay: $________ /hr (if applicable)Anticipated amount of OT: ____/hrs per week / bi-weekly / monthly (circle one)

8. Anticipated Tips, Commissions, Bonuses $ per

9. Do you anticipate any changes in salary in the next 12 months? YES NO (circle one)If yes, please explain:

10. If work is seasonal or sporadic, indicate layoff period:

This information is provided in strict confidence by:

____________________________ _______________________________________Signature of Employer Printed Name of Employer/Title

____________________________ _______________________________________Company Name Company Address

____________________________ _______________________________________Daytime Phone Number Date

Warning: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make a willful false statement ormisrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction.


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COMMON GROUNDLANDLORD VERIFICATION FORM

I hereby authorize the release of the requested information, which will be kept confidential and used forprogram purposes only. Common Ground will call to verify this information.

_____________________________ _______________________________________Applicants Name (printed) Applicants Signature

Dear Landlord:As the Central Intake Unit of Common Ground, we have been authorized to verify the information provided bythe individual whose signature appears above. Thank you for your assistance.

Please complete and return to:

Common Ground Fax: 212-302-8147Central Intake Unit Attention:255 West 43rdStreetNY, NY 10036

1. Resides, or once resided, at the following apartment (list address):

2. Length and dates of residence:

3. Monthly Rent Amountcurrent or time of move out:

4. Timeliness of Rent Payments in last 12 months (or 12 months prior to move out):

Paid in full and by date rent was due in each month

Did not pay in full and on time each monthplease explain:

5. Care of Premises:

6. Do you plan to, or did you, return the applicants security deposit in full? YES NOIf no, why?

7. Are you aware of any incidents relating to the applicant that required police presence at the premises?

YES NO

If yes, please explain:

8. Other Comments:

This information is provided in strict confidence by:

____________________________ _______________________________________PRINT Name Signature

____________________________ _______________________________________Title (e.g. Primary lessee, Managing Agent, etc.) Address

____________________________ _______________________________________Daytime Phone Number Date


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CompanyStamp

orSeal

isMandatory

COMMON GROUNDASSET VERIFICATION FORM

I hereby authorize the release of the requested information, which will be kept confidential and used for program purposesonly. Common Ground will call to verify this information.

_____________________________ _______________________________________Applicants Name (printed) Applicants Signature

Dear Financial Institution,

The above named person is an applicant/participant to/in a federal housing program regulated by the Internal RevenueService (IRS). The IRS program rules require verification of all income information. We ask your cooperation in providingthe requested information. Thank you for your assistance.

All sections must be answeredif one does not apply to a particular account, please write N/A. Please return to:

Common Ground Fax: 212-302-8147Central Intake Unit Attention:255 West 43

rdStreet

New York, NY 10036

1. Checking Account(s)use #2 to indicate non-checking accounts.

Account Number(s)Average Six-Month Balance

WithdrawalPenalty

Interest Rate(expressed as a

percentage) OR

YTD DividendsEarned (expressedas a dollar amount)

2. Savings Account(s)/Certificate of Deposit(s)/Other Non-Checking Accounts

Account Number(s) Current BalanceWithdrawal

Penalty

Interest Rate(expressed as a

percentage) OR

YTD DividendsEarned (expressedas a dollar amount)

I certify that the above information is true and correct.

Name of Company Official Title of Company Official

Signature Company

Date Address

Telephone Number City, State, Zip Code

WARNING: Section 1001 of Title 18 of the US Code makes it a criminal offense to makea willful false statement or misrepresentations to any Department or Agency of the UnitedStates as to any matter within its jurisdiction.

schermerhorn application

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