App fee - CDC Income Certification Intake Form

CDC Income Certification Intake Form

This form provides us the information to verify your annual household income. Income verification is a requirement for residency in Core Housing or Affordable units. You must truthfully disclose all income and assets and upload source documentation. You may want to gather electronic copies of your verification documents before you start this form. All adult members of the household must complete their own application. There is a $225 administrative fee charged for application processing. It is separate from fees charged by property management.
General Questions
Who is completing this verification?*
Are you completing the application for yourself or as a POA?*

For selfAs POA
What community are you applying to?*
How many total members are in your household?*
How many members of your household are over the age of 18?*
State the name and age of all adult household members*
Indicate the ages of all household members 17 years or younger
What unit size are you applying to live in?

One BedroomTwo BedroomThree Bedroom
The Following Questions Are About Your Income

Only YOUR income - all adult household members need to complete their own application. This form uses HIPAA level protections for your data.
Are you employed?*

YesNo
What is the name(s) of your job(s)/employer(s)?
What is your total annual income from the indicated source(s)?
Upload your most recent 3 months of pay history (6 pay stubs if you are paid bi-weekly)

Browse Files

Cancelof
Do you have gig income? (i.e: stock trading, rideshare, food delivery, online sales, scrapping, labor paid in cash, any non-W2 activity that brings your income)*

YesNo
What is your gig activity and what is your average monthly income from the activity?
Upload documentation verifying the amount (i.e: self certification, venmo/cashapp/robinhood activity)

Browse Files

Cancelof
Do you receive public assistance?*

YesNo
What kind of public assistance do you receive?
Please upload your annual award statement

Browse Files

Cancelof
For Core Housing applicants only: I First Name Last Name receive Type a label in the amount of $ per month.
Do you or any dependent children receive social security?*

YesNo
Please upload the award letter / proof of income

Browse Files

Cancelof
For Core Housing applicants only: I First Name Last Name receive Amount in the amount of $ Amount per month.
Do you have a pension?*

YesNo
Indicate the name(s) of the company(ies) for which you receive a pension
Upload your most current statement for each pension

Browse Files

Cancelof
Do you receive veterans benefits?*

YesNo
Upload proof of income

Browse Files

Cancelof
Do you receive alimony?*

YesNo
Upload your divorce decree

Browse Files

Cancelof
Do you receive child support?*

YesNo
Upload your divorce decree and child support enforcement documentation

Browse Files

Cancelof
Are you on unemployment?*

YesNo
Upload a statement from unemployment office and pay stubs

Browse Files

Cancelof
Do you receive workman's comp?*

YesNo
Upload your statement

Browse Files

Cancelof
Do you receive military pay?*

YesNo
Upload the 3 most recent consecutive months of pay stubs

Browse Files

Cancelof
Do you have lottery winnings?*

YesNo
Upload 1099

Browse Files

Cancelof
I receive in the amount of $ Amount
Are you a college student?*

YesNo
Upload your current cost of attendance

Browse Files

Cancelof
Do you receive financial aid?

YesNo
Upload your financial aid award letter(s)

Browse Files

Cancelof
The Following Questions Are About Your Assets

This form uses HIPAA level protections for your data.
Do you have a checking account?*

YesNo
You will complete the following information for each of your checking accounts.
What is the name of the institution(s) where you have your checking account(s) and the last 4 digits of the account number?
Upload the 3 most recent monthly statements for each account listed

Browse Files

Cancelof
Do you have a savings account?*

YesNo
You will complete the following information for each of your savings accounts.
What is the name of the institution(s) where you have your savings account(s) and the last 4 digits of the account number?
Upload the 3 most recent monthly statements for each account listed

Browse Files

Cancelof
Do you have certificate(s) of deposit?*

YesNo
You will complete the following information for each of your certificate of deposits.
What is the name of the institution(s) where you have your certificate of deposit account and the last 4 digits of the account number?
Upload the most recent statement for each CD listed

Browse Files

Cancelof
Do you have stocks, bonds, treasury bills?*

YesNo
You will complete the following information for each of your investment accounts.
What is the name of the institution(s) where you maintain investments, and the last 4 digits of the account number?
Upload the last 3 months statements for each actively traded accounts, or the most recent statement for passive accounts listed

Browse Files

Cancelof
Do you have an IRA or 401K?*

YesNo
You will complete the following for each IRA/401K.
What is the name of the institution(s) where you have your IRA, and the last 4 digits of the account number?
Upload the most recent account statement for each account listed

Browse Files

Cancelof
Other Assets
Have you received a lump sum of greater than $2000 value in the past 24 months?*

YesNo
Upload documentation or self-verification statement

Browse Files

Cancelof
I First Name Last Name verify that I received a lump sum of $ Amount in the past 24 months.
Do you have whole life insurance?*

YesNo
Upload the most recent whole life policy statement

Browse Files

Cancelof
Do you have cash at home or anywhere else?*

YesNo
I First Name Last Name certify that I currently have $ Amount in cash
Do you have other investments such as silver, gold, coins, or collectibles?*

YesNo
I First Name Last Name certify that I have alternative investments in Type valued at $ Amount
Have you disposed of any cash or assets for less than fair market value in the past 24 months?*

YesNo
I disposed of item valued at $ amount and received $ amount in compensation on Date
Have you made secured or unsecured loans that are currently being repaid or you expect repayment in the future?*

YesNo
Upload a signed statement detailing the amount, date, and terms of your loan

Browse Files

Cancelof
Do you own real estate?*

YesNo
You will be asked to complete the following information for each real estate property you own.
Complete the following for each real estate property you own
Core Housing/Affordable rents are intended for households that might not otherwise afford housing in the community. I affirm that the information I have provided is true and that I have not knowingly withheld information on my household income and assets. I understand that completing this form does not guarantee my eligibility. I agree to assist staff that may reach out to me for additional information. I understand that my application may be rejected if I fail to respond adequately to additional information requests within the next 14 days.
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Preferred contact method

PhoneEmail
Date*

MonthDayYear
Date
Signature*

Clear

My Products*

Core Housing Income Certification$225.00

Quantity
Item subtotal:$0.00

Total $0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

CDC Income Certification Intake Form

General Questions

The Following Questions Are About Your Income

The Following Questions Are About Your Assets

Payment Methods