Please note that the online application must be completed in one sitting, our online form does NOT save and can't be completed later. If you prefer, you can download our PDF version
 

Please press submit once complete.

Date
Date
Name of Prospective Tenant *
Name of Prospective Tenant
Gender
Address
Address
Phone
Phone
Date of Birth (optional)
Date of Birth (optional)
Marital Status
Employer Phone
Employer Phone
Interested in:
Rental History
Previous Address
Previous Address
Move In Date
Move In Date
Move Out Date
Move Out Date
Landlord Phone
Landlord Phone
Landlord Address
Landlord Address
Previous Address
Previous Address
Move In Date
Move In Date
Move Out Date
Move Out Date
Landlord Phone
Landlord Phone
Landlord Address
Landlord Address
Section 3
Previous Address
Previous Address
Move In Date
Move In Date
Move Out
Move Out
Landlord Phone
Landlord Phone
Landlord Address
Landlord Address
Contact Information
Address
Address
POA?
Home Phone
Home Phone
Cell Phone
Cell Phone
Address
Address
POA
Home Phone
Home Phone
Cell Phone
Cell Phone
Personal References
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Applicant's Assets
$
$
$
Stocks/Bonds
$
$
$
$
$
$
$
Applicant's Monthly Income
$
$
$
$
$
$
$
Applicant Certification: I agree that, to the best of my knowledge, the information provided is accurate and complete. I understand that the Charles P. and Margaret E. Polk Foundation will rely upon the accuracy and completeness of the above information in making a decision. I understand this application may be subject to a criminal background check and hereby authorize the Charles P. and Margaret E. Polk Foundation to perform said background check. I authorize the release of information from previous or current landlord(s), if applicable.
Date *
Date
The Charles P. and Margaret E. Polk Foundation does not discriminate in the provision of services, including occupancy, on the basis of race, color, creed, national origin, age, sex, marital status, sponsorship, or handicap.
Health Questionaire if 75 or Older
Do you use an assistive device?
Are you able to care for your apartment without assistance?
Are you able to care for your everyday needs without assistance?
Do you have funeral arrangements?
Do you have a Power of Attorney (POA)?