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Applicant Contact Information
Head of Household*
Head of Household
First Middle Initial Last
Current Address*
Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Phone Number
Type of Phone*
- Cell
- Home
- Work
Email*
Email Address
How did you hear about us?*
How did you hear about us?
Property of Interest*
Property Interest
Additional Properties of Interest
Additional Properties of Interest
Bedroom Size Needed*
Desired Date of Occupancy*
MM slash DD slash YYYY

Household Composition
All household members (including those part-time) must be listed below:
Household Member #1 (Head of Household)*
Household Member #1 (Head of Household)
First Middle Initial Last
Date of Birth*
MM slash DD slash YYYY
Social Security Number*
Social Security Number
Driver's License Number*
Driver's License State*
Student?*
Student?
- Yes
- No
Household Member #2
Household Member #2
First Middle Initial Last
Relationship to Head of Household
Date of Birth
MM slash DD slash YYYY
Social Security Number
Driver's License Number
(if 18 years or older)
Driver's License State
(if 18 years or older)
Student?
Student?
- Yes
- No
Household Member #3
Household Member #3
First Middle Initial Last
Relationship to Head of Household
Date of Birth
MM slash DD slash YYYY
Social Security Number
Driver's License Number
(if 18 years or older)
Driver's License State
(if 18 years or older)
Student?
Student?
- Yes
- No
Household Member #4
Household Member #4
First Middle Initial Last
Relationship to Head of Household
Date of Birth
MM slash DD slash YYYY
Social Security Number
Driver's License Number
(if 18 years or older)
Driver's License State
(if 18 years or older)
Student?
Student?
- Yes
- No
Household Member #5
Household Member #5
First Middle Initial Last
Relationship to Head of Household
Date of Birth
MM slash DD slash YYYY
Social Security Number
Driver's License Number
(if 18 years or older)
Driver's License State
(if 18 years or older)
Student?
Student?
- Yes
- No

1. Have there been any changes in the household in the last twelve months?*
1) Have there been any changes in the household in the last twelve months?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
2. Do you anticipate any changes to the household composition in the next twelve months?*
2) Do you anticipate any changes to the household composition in the next twelve months?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
3. Is there someone not listed previously who would normally be living in the household?*
3) Is there someone not listed previously who would normally be living in the household?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
4. Has any member of the household been convicted of a felony?*
4) Has any member of the household been convicted of a felony?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
5. Will all of the persons in the household be or have been full-time students during five calendar months this year or plan to be in the next calendar year at an education institution (other than a correspondence school) with regular faculty and students?*
5) Will all of the persons in the household be or have been full-time students during five calendar months this year or plan to be in the next calendar year at an education institution (other than a correspondence school) with regular faculty and students?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
6. Has any member of the household been evicted from housing?*
6) Has any member of the household been evicted from housing?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
7. Has any member of the household ever declared bankruptcy?*
7) Has any member of the household ever declared bankruptcy?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
8. Per Vermont State regulations all landlords are required to collect data on homelessness. Are you currently homeless or at risk of homelessness?*
8) Per Vermont State regulations all landlords are required to collect data on homelessness. Are you currently homeless or at risk of homelessness?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
Residential History
Please indicate your place(s) of residence for the past three years below:
Current Address*
Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Landlord Name & Contact Info*
Landlord Name, Phone Number, Email Address
Rent or Own?*
- Rent
- Own
Dates of Residency*
Monthly Rent/Mortgage*
Previous Address #1*
If you have been at your current address for 3+ years, please fill out N/A in the fields below. If you have not been at your current address for 3 years, please fill out below.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Landlord Name & Contact Info*
Landlord Name, Phone Number, Email Address
Rent or Own?*
- Rent
- Own
Dates of Residency*
Monthly Rent/Mortgage*
Previous Address #2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Landlord Name & Contact Info
Landlord Name, Phone Number, Email Address
Rent or Own?
- Rent
- Own
Dates of Residency
Monthly Rent/Mortgage
Previous Address #3
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Landlord Name & Contact Info
Landlord Name, Phone Number, Email Address
Rent or Own?
- Rent
- Own
Dates of Residency
Monthly Rent/Mortgage

Living Needs
9) What is the household's reason for moving?*
9) What is the household's reason for moving?
10) Will any household member require any reasonable accommodations?*
10) Will any household member require any reasonable accommodations?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
11) How many vehicles do you have?
- None
- 1 vehicle
- 2 vehicles
- 3+ vehicles
1st Vehicle Description*
1st Vehicle Description
2nd Vehicle Description
2nd Vehicle Description
3rd Vehicle Description
3rd Vehicle Description
12) Does your household have any pets?*
12) Does your household have any pets?
- Yes
- No
1st Pet Description
1st Pet Description
2nd Pet Description
2nd Pet Description
3rd Pet Description
3rd Pet Description
Income & Assets
13) Do you anticipate any changes in your income in the next twelve months?*
13) Do you anticipate any changes in your income in the next twelve months?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
14) Is any member of the household likely to receive assistance (monetary or not) from someone who is not a member of the household?*
14) Is any member of the household likely to receive assistance (monetary or not) from someone who is not a member of the household?
- Yes
- No
If you answered yes, please explain:
If you answered yes, please explain:
15) Does the household currently have a Section 8 Housing Choice voucher?*
15) Does the household currently have a Section 8 Housing Choice voucher?
- Yes
- No
If you answered yes, which Public Housing Authority?
If you answered yes, which Public Housing Authority?
16) Is anyone in the household currently employed?
16) Is anyone in the household currently employed?
- Yes
- No
If yes, please complete the following for each household member that is employed.
Household Member #1 Name*
Household Member #1 Name
First Last
Household Member #1 Employer*
Household Member #1 Income*
Household Member #2 Name
Household Member #2 Name
First Last
Household Member #2 Employer
Household Member #2 Income
Household Member #3 Name
Household Member #3 Name
First Last
Household Member #3 Employer
Household Member #3 Income
Household Member #4 Name
Household Member #4 Name
First Last
Household Member #4 Employer
Household Member #4 Income
17) Is anyone in the household responsible for paying child support or alimony?*
17) Is anyone in the household responsible for paying child support or alimony?
- Yes
- No
If you answered yes, please provide monthly amounts:
If you answered yes, please provide monthly amounts:

Please provide all sources of income for all members of the household below. Include and identify as Employment Wages, SSDI, SSI, Pension, Investment Distribution, Long Term Medical Care, Interest Income, Alimony or Child Support, or Other:
Household Member #1 Name*
Household Member #1 Name
First Last
Source of Income
Please select sources of income below:
Gross Monthly Amount
Please enter income associated with selected sources above:
Section Break
Household Member #2 Name
Household Member #2 Name
First Last
Source of Income
Please select sources of income below:
Gross Monthly Amount
Please enter income associated with selected sources above:
Section Break
Household Member #3 Name
Household Member #3 Name
First Last
Source of Income
Please select sources of income below:
Gross Monthly Amount
Please enter income associated with selected sources above:
Household Member #4 Name
Household Member #4 Name
First Last
Source of Income
Please select sources of income below:
Gross Monthly Amount
Please enter income associated with selected sources above:
Emergency Contact
18) List someone in the area that is not already on the application
Name*
Emergency Contact Name
First Last
Address*
Emergency Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Emergency Phone
Relationship
Years Known

Certification
I understand that the information contained in this application will be used to determine my eligibility for housing. I grant consent for the management to make any and all inquiries to verify the information, with rental, criminal and credit screening services, and to contact previous and current landlords or other sources for credit, and verification of other information which may be released to appropriate Federal, State and Local Agencies. I authorize management to obtain one or more “credit and consumer reports” as defined in the Fair Credit Reporting Act, 15 U.S.C. Section 1681 a(d), seeking information on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. In the event my application is approved, I also give my consent to have Summit Properties and/or its assigned credit bureau to obtain additional credit reports and other information after approval of my credit, both in connection with same Transaction or an extension of credit; to obtain credit reports, criminal background checks and other information for account review purposes and other legitimate purposes associated with the account. Furthermore, I understand that providing any false or misleading information will make me ineligible for rental assistance and may result in prosecution by the United States Government. Therefore, I certify that all of the above information is true and complete to the best of my knowledge and belief. All members of the household who are 18 years of age or older must sign this application below:
Primary Applicant's Name*
Primary Applicant's Name
First Last
Today's Date*
Today's Date
MM slash DD slash YYYY
Attestation
- By checking this box, I hereby submit this online application for an apartment and in doing so, certify that this information is correct and authorize you to contact any references that I have listed and perform a credit check with Credit Profile & Security Corp.
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7 ASPEN DRIVE, SUITE #1, SOUTH BURLINGTON, VT 05403

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7 ASPEN DRIVE, SUITE #1, SOUTH BURLINGTON, VT 05403 | (802) 846-5430 | EMAIL US | GET DIRECTIONS | EMPLOYMENT

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