BALTIMORE HOTEL HOUSING APPLICATION ***READ BEFORE BEGINNING***This application takes 15-30 minutes to complete. You cannot save your progress, so make sure you have enough time to finish before you begin. You can also print out an application from out website and mail it in. TO COMPLETE THIS APPLICATION YOU WILL NEED: Your Social Security number. A photo or scan of your driver's license or state ID. A photo or scan of your proof of income (examples: pay stub, benefits letter). Contact information for your case worker, current landlord, current employer (if you have these) and for two character references (required). Vehicle information (make/model/license plate) for any vehicle you own or use regularly. Your Name* Social Security Number* Driver's Licence or State ID Number Your Phone Number Your Email Address ATTACH AN IMAGE OF YOUR GOVERNMENT-ISSUED PHOTO ID (REQUIRED)* ATTACH AN IMAGE OR SCAN OF YOUR INCOME VERIFICATION FOR ALL INCOME SOURCES, SUCH AS: Pay Stub, SSI Check Stub, GA Check Stub, etc. (REQUIRED)* Do you currently have a Case Manager? *NoYes Case Manager Name Case Manager Email Case Manager Phone Case Manager Agency/Organization Date of Birth*01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 2018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Please check ALL types of assistance you are currently receiving. Section 8 VoucherSNAPCalFreshSocial SecurityUnemploymentGR (General Relief)Other (Please Specify) Your Current Address* Street Address or Cross Streets City State / Province Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Your Previous Address Street Address City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Please check all boxes that describe your current living situation. Currently in stable housing. Homeless, staying on the street.Homeless, staying in my car. Homeless, staying at a shelter.Homeless, staying with friends/family.Homeless, staying in transitional housing.Losing current housing due to eviction. Losing current housing due to fleeing abuse. Losing current housing due to other reasons. Other (Please specify) How did you hear about us? Walk InFriendCase ManagerAgency ReferralEmployee ReferralOther (please explain) Current Landlord Name Current Landlord Phone Monthly rent amount you are currently paying USD Do you have a car or other vehicle? NoYes (If yes, please fill out vehicle info below) Vehicle Licence Plate Vehicle State Registered Vehicle Year Vehicle Make Vehicle Model Vehicle Color Do you have pets? *NoYes - 1-2 catsYes - 1-2 small dogs (under 25 pounds)Yes - 1-2 large dogs (over 25 pounds)Yes - 3 or more animalsYes - Other type of animal (please specify) If you have pets, can you provide a Certificate of Good Health/Proof of Vaccination/Service Animal Certification for all your animals?*Yes - I can provide this for my animals.No - I cannot provide this for my animals.I do not have animals. Have you ever been evicted or had an unlawful detainer filed against you? *YesNo Do you have any credit problems?*YesNo Have you ever been convicted of drug trafficking? (Examples: Selling, distributing, importing/exporting controlled substances?) *YesNo Have you ever been convicted of a felony? *NoYes - Please indicate the YEAR and STATE you were convinced (example: 1987, CA) Have you ever been convicted for a crime against persons? If yes, check all below that apply. *No - I have not ever been convicted of a crime against personsYes - Robbery/Aggravated RobberyYes - Manslaughter/Murder/Attempted Murder Yes - Sexual Assault/RapeYes - Battery/Assault/Aggravated AssaultYes - Other (Please specify) You may explain any "YES" answers for the previous five questions. (If you answered "YES" to any convictions, please list the year and state.) OPTIONAL (does not impact your application): Would you consider being interviewed or speaking publicly about your experience with the Healthy Housing Foundation?YesNoMaybe Applicant represents that statements made are true, correct and hereby authorizes verification of references to include but not limited to credit checks, unlawful detainer checks & credit checks and agrees to furnish additional credit references on request. I authorize verification of the information contained herein solely for the purpose of establishing my qualifications as a tenant. I release anyone verifying such information or providing information, from liability. I understand that incomplete or incorrect information provided in the application, may cause a delay in processing and can result in denial of tenancy. I understand that even if I am granted a residence based on my initial credit check, that a fuller credit check will still be conducted up to 30 days after my initial application. I understand that if this fuller credit check reveals falsified information in my application that this is grounds for eviction and I may be denied further housing with the Healthy Housing Foundation. *Check here to accept these terms TYPE YOUR FULL, LEGAL NAME IN THE BOX BELOW TO ELECTRONICALLY SIGN THIS FORM. (REQUIRED) * Today's Date* List the full legal names and ages of all people who will live in the unit (including yourself). *1. 2. 3. 4.SubmitReset