Page 1 of 1

Crossroads Village MHA tenant application form 2025

Last name, First name

Current street address, City, State and Zip Code

email address

phone number

Birthdate

Gender or pronoun (if you have a preference)

Please list the roommates you plan to live with. List names, age(s), and relation to each

Please list your housing history for the past 10 years: whether you're a leaseholder, roommate, house owner etc.

If chosen as a tenant, how long do you plan to live in t he apartment that you are applying
for?

List your current employer and past three employers+ job titles held, annual salary or hourly wage

List other sources of income

Please list incomes for any person(s) who you plan to live with in this apartment.

Do you or any member of your household have any special housing needs due to disability, vision or hearing impairment, or for any other reason? If yes, please explain.

Do you smoke?

Do you smoke?

I/we understand that the information in this application is being requested to determine eligibility for tenancy in an available apartment at Crossroads Village MHA.

I/we understand that the information in this application is being requested to determine eligibility for tenancy in an available apartment at Crossroads Village MHA.

I/we authorize Crossroads Village MHA to verify all information provided on this application and to contact previous or current landlords, employers, references or other sources for background information.

I/we authorize Crossroads Village MHA to verify all information provided on this application and to contact previous or current landlords, employers, references or other sources for background information.

I/we certify that the statements made in the is application are true and complete to the best of my/our knowledge.

I/we certify that the statements made in the is application are true and complete to the best of my/our knowledge.

I/we understand that false statements or information will disqualify my application.

I/we understand that false statements or information will disqualify my application.

If chosen as a potential tenant, I/we understand that a credit check and a criminal background check will be processed for every adult aged 18 or older as part of the eligibility requirements.

If chosen as a potential tenant, I/we understand that a credit check and a criminal background check will be processed for every adult aged 18 or older as part of the eligibility requirements.

Please describe your interest in living in a cooperatively run building. Have you had any experience living in a housing cooperative or with other types of cooperatives, or in another group living situations.

What interests, skills, background or experience that you would bring to help this community?

Have you participated in volunteer (unpaid) community work in the past five years? Describe your experience.

How would you describe your strengths and weaknesses in group decision-making, problem solving and doing tasks as part of a group or team? What do you see as advantages or drawbacks of such group efforts

On average, how many hours per month do you think you could contribute to our housing cooperative if you are accepted?

Please describe a time when you worked out a conflict with a neighbor or housemate and how did it turn out ? What did you learn from the experience?

Are there any "must-haves" for your living situation such as noise level, pet, live on a certain floor, etc.

Please list your three PROFESSIONAL references along with their contact information

Administrative skills Inventory. Please check the skills that apply to you or your interest level

Administrative skills Inventory. Please check the skills that apply to you or your interest level

General maintenance or handyman skills inventory

General maintenance or handyman skills inventory