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Austin Manor Apartments

Elizabeth Harvey Apartments

Excelsior Apartments

Gratwick Manor Apartments

Haskell Stovroff Apartments

Nelson Hopkins Apartments

Home » Programs » Property Management » Rental Application

Rental Application

Please fill out the information requested below. Required fields are in bold.

Please select which apartment building you wish to apply for:

Excelsior Apartments 130 Central Ave Buf
Gratwick Manor 840 Tonawanda St. Buf
Austin Manor 395 Tonawanda St. Buf
Elizabeth Harvey Apartments 525 Oliver St. N. Tonawanda
Haskell Stovroff Apartments 30 Alpine Pl. Buf
Nelson Hopkins Apartments – 5562 Davison Rd. Lockport

Acceptance of this application does not guarantee rental of an apartment. All applicants must meet screening criteria, including landlord credit and criminal background checks. Changes in family income, size and address must be reported promptly to the Olmstead Center in order to properly process your application. A security deposit and lease is required. Student status Regulations will vary depending on which apartment building you are applying for.

Personal Information

Applicant's Full Name:

Phone:

Please enter phone as ###-###-####

Driver's License Number & State

Co-Applicant's Full Name:

Phone:

Please enter phone as ###-###-####

Driver's License Number & State

Full Names of all Other Household Members	Driver's License No.	State

How did you hear about this complex?

Eligibility Information

Our apartment complexes are funded under the NYS Housing Trust Fund, the Federal Low Income Housing Tax Credit Programs, and the U.S. Department of Housing and Urban Development, and are designed for persons with physical disabilities, in particular, persons who are blind or visually impaired. Applicants may be admitted only if the household is income eligible. In some cases, households consisting entirely of full time students are not eligible for this housing. For purposes of this application, any individual is considered a student who has been or will be a full time student at an educational institution with regular facilities. (NOT correspondence or exclusively at night school.) A student is considered full time if enrolled at least five months in the calendar year, and the amount of hours taken are considered full-time by the school attended. Students in elementary, middle and high schools are always full-time. The following income and student status information is required to determine eligibility.

Are you a full time student?

Yes
No

In the spaces provided below, list the income and benefits received by ALL members of your household INCLUDING ANYONE WHO IS LIVING WITH YOU BUT IS NOT RELATED TO YOU

Income/Benefit	Amount	Indicate If Weekly, monthly Or annually	Name of Household Member Who recieves benefit	Number of Accounts
Employment (before deductions)
NYS Disability/ Workmen’s Compensation
Social Security/ SSIn
Veteran's Benefits
Retirement Pensions/ Annuities
Social Services (Public Assistance) Do not Include Food Stamps
Unemployment Insurance Benefits
Child Support / Alimony
Self-Employment
Other (Please Specify)
Value of Assets
Cash in Checking Account (No. of accounts)
Cash in Savings Account (No. of Accounts)
Certificate of Deposit (No. of Accounts)
Stock / Bond Value
RA / Keough Accounts (No. of Accounts)
Real Estate Owned
Other (Please Specify)

Has any member of your household disposed of assets for less than fair market value in the past 2 years?

Yes
No

Residence History

Professional property managers look for tenants who will pay rent on time, take care not to damage an apartment, and be considerate neighbor. The following information is requested to help us determine if you have demonstrated these qualities in the past.
ALL REFERENCES MUST BE COMPLETE INCLUDING FULL NAME, STREET, CITY/TOWN, STATE, ZIP AND PHONE

Present Address:

Date of Birth:

Dates:

from to

Rent

$ /month

Utilities Included?

Yes
No

Reason for Moving:

Landlord Name:

Phone:

Landlord Address

Previous Address:

Dates:

from to

Rent

$ /month

Utilities Included?

Yes
No

Reason for Moving:

Landlord Name:

Phone

Landlord Address

Previous Address:

Dates:

from to

Rent

$ /month

Utilities Included?

Yes
No

Reason for Moving:

Landlord Name:

Phone

Landlord Address

If you do not have a previous rental history, list at least two individuals that could verify your ability to live by the conditions of a lease (For example, an employer, caseworker or clergy).

Name	Address	Phone

Have you or your co-applicant ever been evicted from rental housing for lease violations?

Yes
No

Have you or your co-applicant ever broken a Rental Agreement or Lease?

Yes
No

Have you or you co-applicant ever been sued for damage to rental Property?

Yes
No

Have you or your co-applicant ever engaged in criminal activity?

Yes
No

If you answered yes to any of these questions, Please explain

We welcome applicants with Rental Assistance. Are you currently participating in the Section 8 Certificate or Voucher Program?

Yes
No

Application Certification

The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this Program. You are not required to furnish this information, but encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.

Ethnicity:

Hispanic or Latino
Not Hispanic or Latino

Race: (mark one or more)

Caucasian
African American
American Indian/ Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Other