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217-854-5393

PO Box 303, 760 Anderson Street Carlinville, IL 62626

Application

Application Form

Fields marked with * are required.
(INCLUDE ALL LAST NAMES i.e. MAIDEN & MARRIED NAMES)
Add a Member
Please be sure that you include every previous name or alias in order to process this application accurately
Name/Address and Phone Numbers of Current/Previous Landlords (last two if applicable):
Current Landlord
Previous Landlord
 
Is anyone in the household pregnant?
Would you be interested or have a need for a handicapped accessible unit?
Are you or another Adult Member in the household working?
Are any family members temporarily absent from the home?
Are you a victim of Domestic Violence?
Are you displaced?
Are you homeless?
Have you or anyone who will live in the rental home ever been arrested and/or convicted of any crime other than traffic violations? (This includes charges that were dropped or dismissed)
Have you or anyone who will live in the rental home been arrested within the last 12 months?
Do you have any current charges pending against you or anyone who will live in the rental home?
Check which waiting list(s) you wish to be placed? You can be placed on one or more of the following waiting lists.
Interested in a: