Rental Application: Louise C. Stokes Scholar House
Page 1
Are you currently a full-time student at an accredited Ohio Institute of learning?
Please select...
Yes
No
Which Institution?
Are you a high school graduate attending college this semester for the first time?
Please select...
Yes
No
Are you the head of household with at least one minor child dependent and attending school fulltime?
Please select...
Yes
No
Please list the age of your dependents here
Do you have at least one year of remaining coursework required before graduation?
Please select...
Yes
No
Do you currently have a GPA of 2.0 or higher?
Please select...
Yes
No
Edit this heading
Page 2
First Name
Last Name
Birthdate
Social Security Number
Current Street Address
Current City
Current State
Current Zip code
Email Address
Mobile Phone
Alternative Phone
Length of residency at your current address
Please select...
1 year or less
2 years
3 years
4 years
5 years
6 years
7 + years
If less than 2 years, do you have two years of verifiable residency history?
Please select...
Yes
No
Page 3
How many additional adults live in the household
Please select...
0
1
2
3
4
5
6
7
8
9
10
Additional
Adult
Household Members
Please list the name(s) of all additional
adults
, as well as their birthdates. Please click "Add additional household member" for each entry needed.
First Name
Last Name
Birthdate
Total number of Household Members (
Children and Adults
)
Please select...
1
2
3
4
5
6
7
8
9
10+
Does your household need an ADA Home?
Please select...
Yes
No
How much is the gross combined (before tax)
monthly
income of all adults that will be on the lease?
Do you receive any type of Rental Assistance
Please select...
Yes
No
What type of assistance did you receive?
Do you owe CMHA or CHN any past due errors?
Please select...
Yes
No
Have you or anyone in your household been evicted within the last 2 years?
Please select...
Yes
No
Have you or anyone in your household been convicted of a felony within the last five years?
Please select...
Yes
No
Is anyone in the household a registered sex offender?
Please select...
Yes
No
Have you had to file for bankruptcy within the past two years?
Please select...
Yes
No
Are you are any family member, now, or previously during the last 12 months an employee, agent, consultant, officer, elected, or appointed official of the City of Cleveland, Community Development Department, of the CHN Housing Partners (CHN), or any CHN member organization or any contractor doing business with CHN?
Definitions: A "family member" is defined as the employee's spouse and everyone who is related to the employee or employee's spouse in the following ways: parents, children, grandparents, grandchildren, brothers, sisters, aunts, uncles, nieces, nephews, step relatives and half relatives.
Please select...
Yes
No
How did you hear about us?
Please select...
Cuyahoga Community College
Cleveland State University
CHN Website
Social Media
TV News
Other
How did you hear about us?
I hearby certify that the information stated above is true, correct and complete to the best of my knowledge. I further understand and agree that if any of the information I have provided in this pre-application is found to be incomplete, incorrect or false, it will be grounds for denial of this pre-application or termination of my tenancy. I further understand that this pre-application does not guarantee housing or a position on a waiting list. I further understand that my signature below provides CHN Housing Partners the ability to communicate with me via text messaging or email via the information provided on this form. To sign, please type your name below and then select the "Signed Date" Signature
Signed Date
Thank you for applying. Please note, we will not begin screening applicants for eligibility until July 2023 and units will not be ready until November 2023.
Contact Information