Winn Theroch Apartments

Theroch Apartments

Managed by Winn Residential: 133 Columbia Rd, Dorchester MA 02121-3117
Concatenated Name + SSN + DOB + Label
Office Only - HWs Staff Code
Applicant leave this field BLANK.
Actual Submission Date-Time (must match date/time stamp on the Application)*

YearMonthDay
Date
Hour MinutesAM/PM Option
App entered by HWs staff

Yes

This is A Housing Application You Can Complete with Your Cellphone or a Computer!

Read these items and save your time and frustration.

1:	In the top right-hand corner of this page, select your desired language.
2:	You won't be able to submit this application if you skip questions with a red asterisk (*) so make sure you answer all the required questions. But a few sections contain only optional questions, and you can skip these sections if none of the questions apply to you.
3:	Using this form is safer than email or mail! This application is encrypted, so your answers will be sent in code. Here's how one answer might look when submitted:
	##!#D^C14$C&SD()^DG#KLD)SDDGCHG&C&LS)CNG#^^D%GISD^#^

Agreement
- All your answers should contain both Upper-Case and lower-case letters, for example:
- Your answer for Annual Income must be how much you receive in a YEAR, not how much you get each MONTH - and not an HOURLY wage. Also, your income should include things like: Food Stamps, TANF, EAEDC, SS, child support, welfare, employment, canning, etc.
- If any household member has a SSN or ITIN, you are REQUIRED to provide the full number.
I understand that, when I enter my full name in the fields below, I must include ALL present and former legal names. Examples: If I am married, I must also include my former last name. if divorced, I must include my former married name. If I am Spanish, I must include all my last names. If I have a middle name, I must include the full middle name. THIS IS ESSENTIALINFORMATION.*

YesNo
I understand and agree to follow these instructions

YesNo (you will not be able to submit this application)
Do you understand that if you have a mobile voucher, you will have to permanently give it up in order to move into a unit at this property?*

Yes
I agree to use both Upper-Case and lower-case letters for all my answers

YesI have a disability that makes it difficult to type in both Upper- and Lower-case; please accept my application anyway.
Substring Widget for SSN
Substring Widget for DOB
What is your first name? Type like this: Jane - don't type 'jane' or 'JANE'*
What is your middle name? (leave BLANK if no middle name)
What are all your last names (ex: Hernandez Gonzalez de Jesus)*
Re-Enter your Full Name*

First NameMiddle Name(s)All Last Names
What was your Mother's LAST NAME when she was a child?*
Mother's LAST Name When She Was a Child - Type 'hw1' if you don't know
Does the Head of Household (that's you) have a SSN or ITIN?*

YesNo
Enter your COMPLETE SSN or ITIN
You MUST include the dashes, see example
Today's Date (Used to Calculate Age)*

MonthDayYear
Date
Enter your birthdate in this format: mm-dd-yyyy*

MonthDayYear
mm-dd-yyyy
Based on your birthdate, your age is
Input Your Gender*

MaleFemaleTransgender Male to FemaleTransgender Female to Male
Your Ethnicity and Race - 1*

Hispanic/LatinoNon-Hispanic/Non-LatinoClient Refused
Your Ethnicity and Race - 2*

American Indian or Alaska NativeAsianBlack or African AmericanMulti-RacialPacific Islander or Native HawaiianWhiteClient Refused
Requires FULL Wheelchair Access*

YesNo
Reasonable Accommodations. Check all that apply:*

Does not require any R.A.Wheelchair Full Access, incl. Roll-in ShowerNo-StepsFirst-FloorBathroom MobilityESU Environmental Sensitivity UnitHearing Impaired UnitVision Impaired UnitDomestic Violence in HistoryPCA Personal Care AttendantInterpreter Needed
Your Career Stage

EmployedUnemployedRetiredFT StudentPT Student
Any Veterans in the household?*

YesNo
Do you currently hold a mobile voucher?*

No or UnknownYes
Type of Mobile Voucher

Section 8 voucherMRVP voucherAHVP voucherVASH voucher
Head of Household: CORI*

No CORI FlagsYes - Possible Felony FlagYes - Possible Misdemeanor Flag
Is anyone in the household subject to a lifetime sex offender registration in any state?*

YesNo
Any pets?*

YesNo
If YES, how many pets do you have?
Enter a NUMBER: 1, 2, 3, etc.
Is/Are your Pets:

Service Animal(s) (documentation may be needed at time of vacancy interviewEmotional Support Animal(s) (documentation may be needed at time of vacancy interview)Regular pet(s)
Describe your pets
Explain the size, type, breed, and name ex: small dog - terrier
Document Date Stamp - MUST match the Date-Time Stamp on Application*

YearMonthDay
Date
Number of adults (18 and over) who will move with you - include yourself!*
You entered "0" for the Number of Adults in your household. But you have to include yourself as the Head of Household, so you answer CANNOT BE "0". Scroll back up the page and change your answer or you won't be able to submit this application.
Number of children (17 and under) who will move with you (enter "0" if none).*
Total Household Size - ALL Adults and Children
Total ANNUAL Income. Include all income from any source, such as Welfare or Food Stamps, SSI, etc. The amount you make in a year!*
Required Fields for Additional Household Members
SECOND Household Member - Full Name

First NameMiddle NameLast Name
SECOND HH Member - Relationship
Does SECOND HH Member have a SSN or ITIN?

YesNo
SECOND HH Member - Social Security Number SSN
SECOND HH Member - Date of Birth
mm-dd-yyyy
THIRD HH Member - Full Name

First NameMiddle NameLast Name
THIRD HH Member - Relationship
Does THIRD HH Member have a SSN or ITIN?

YesNo
THIRD HH Member - Social Security Number SSN
THIRD HH Member - Date of Birth
mm-dd-yyyy
FOURTH Household Member - Full Name

First NameMiddle NameLast Name
FOURTH HH Member - Relationship
Does FOURTH HH Member have a SSN or ITIN?

YesNo
FOURTH Household Member - Social Security Number SSN
FOURTH Household Member - Date of Birth
mm-dd-yyyy
FIFTH HH Member - Full Name

First NameMiddle NameLast Name
FIFTH HH Member - Relationship
Does FIFTH HH Member have a SSN or ITIN?

YesNo
FIFTH HH Member - Social Security Number SSN
FIFTH HH Member - Date of Birth
mm-dd-yyyy
SIXTH Household Member - Full Name

First NameMiddle NameLast Name
SIXTH HH Member - Relationship
Does SIXTH HH Member have a SSN or ITIN?

YesNo
SIXTH HH Member - Social Security Number SSN
SIXTH HH Member - Date of Birth
mm-dd-yyyy
SEVENTH HH Member - Full Name

First NameMiddle NameLast Name
SEVENTH HH Member - Relationship
Does SEVENTH HH Member have a SSN or ITIN?

YesNo
SEVENTH HH Member - Social Security Number SSN
SEVENTH HH Member - Date of Birth
mm-dd-yyyy
EIGHTH HH Member - Full Name

First NameMiddle NameLast Name
EIGHTH HH Member - Relationship
Does EIGHTH HH Member have a SSN or ITIN?

YesNo
EIGHTH HH Member - Social Security Number SSN
EIGHTH HH Member - Date of Birth
mm-dd-yyyy
NINTH HH Member - Full Name

First NameMiddle NameLast Name
NINTH HH Member - Relationship
Does NINTH HH Member have a SSN or ITIN?

YesNo
NINTH HH Member - Social Security Number SSN
NINTH HH Member - Date of Birth
mm-dd-yyyy
TENTH HH Member - Full Name

First NameMiddle NameLast Name
TENTH HH Member - Relationship
Does TENTH HH Member have a SSN or ITIN?

YesNo
TENTH HH Member - Social Security Number SSN
TENTH HH Member - Date of Birth
mm-dd-yyyy
Do any other HH members have a CORI?

Not Applicable because HH of 1No CORI FlagsYes - Possible Felony FlagYes - Possible Misdemeanor Flag
If any member has a CORI, indicate 1. the Nature of the crime and 2. the Date of Conviction.
About Theroch Apartments

If you have a mobile voucher, you will have to surrender it in order to move into this building.

Your portion of the rent will be approximately 1/3 of your income - and you can potentially qualify for subsdized housing even if you have zero income.

CHOOSE A BEDROOM SIZE(s)

The general rule is, "at least 1 person per bedroom and no more than 2 persons per bedroom."

Because these are affordable housing options, the funders place restrictions on what bedroom size you can ask for.

Based on your household composition, you are eligible only for the option that is selected below. If you wish to change this, you must change your household composition.
Desired Bedroom Size. We recommend these based on your Household Size. Change the selection if you wish!*

1BR only2BR only3BR only4BR only5BR onlyBoth 1BR and 2BRBoth 2BR and 3BRBoth 3BR and 4BRBoth 4BR and 5BR2BR and 3BR and 4BR3BR and 4BR and 5BR
Do you need a different BR size based on Reasonable Accommodation (usually medical)? If so you will need to upload documentation that supports your request.

Yes - I will upload supporting documentation below, or change your answer to "No"No
Upload Documents that Support your request for a different Bedroom Size.

The most common supporting document is a letter from a doctor. If you do not have such a letter, change the answer above to "No". But please note that you can always make this request later, when you can provide a supporting document
Cancelof
Any Documented Disabilities?

YesNo
Current Housing Status*

1: Homeless2: Housing Loss in 14 Days (at imminent risk)3: Homeless only under other federal statutes4: Fleeing domestic violence5: At-Risk of Homelessness6: Stably Housed7: Client did not say
If you selected 4: Fleeing domestic violence above, then click here now!

Si seleccionó 4: Huir de la violencia doméstica arriba, haga clic aquí ahora.

Se você selecionou 4: Fugindo da violência doméstica acima, clique aqui agora.

如果您在上面选择了4：逃离家庭暴力，那么现在点击这里.

Если вы выбрали пункт 4: Бегство от домашнего насилия выше, нажмите здесь сейчас.

Si vous avez sélectionné 4 : Fuir la violence domestique ci-dessus, cliquez ici maintenant

Si w chwazi 4: Sove vyolans domestik pi wo a, klike la a kounye a.
Se hai selezionato 4: Fuggire dalla violenza domestica qui sopra, clicca qui adesso.

Nếu bạn chọn 4: Chạy trốn bạo lực gia đình ở trên, hãy nhấp vào đây ngay.

X

If you claim Domestic Violence, you will be required to provide documentation (such as a police report or a letter from a domestic violence agency) at the time of a unit offer. If you can't produce such documentation, any priority status you were presumed to have will disappear and you will be placed back on the waitlist minus any priority claim. (You can now return and finish the application, or change your Domestic Violence answer if you wish, by clicking the "x" at the top of the screen.)

Si reclama violencia doméstica, se le pedirá que proporcione documentación (como un informe policial o una carta de una agencia de violencia doméstica) en el momento de la oferta de unidad. Si no puede presentar dicha documentación, cualquier estatus de prioridad que se suponía que tenía desaparecerá y se le colocará nuevamente en la lista de espera menos cualquier reclamo de prioridad. (Ahora puede regresar y finalizar la solicitud, o cambiar su respuesta sobre Violencia Doméstica si lo desea, haciendo clic en la "x" en la parte superior de la pantalla).

Se você alegar Violência Doméstica, será solicitado que você forneça documentação (como um relatório policial ou uma carta de uma agência de violência doméstica) no momento da oferta de uma unidade. Se você não puder apresentar tal documentação, qualquer status de prioridade que você supostamente possui desaparecerá e você será colocado novamente na lista de espera, sem qualquer reivindicação de prioridade. (Agora você pode retornar e finalizar a inscrição, ou alterar sua resposta sobre Violência Doméstica, se desejar, clicando no “x” na parte superior da tela.)

如果您申请家庭暴力，您将需要在单位录取时提供文件（例如警方报告或家庭暴力机构的信件）。如果您无法出示此类文件，您被认为拥有的任何优先权状态都将消失，并且您将被重新列入候补名单，减去任何优先权主张。（您现在可以返回并完成申请，或者如果您愿意，可以通过单击屏幕顶部的“x”来更改您的家庭暴力答案。）

Если вы заявляете о домашнем насилии, вам вам необходимо будет предоставить документацию (например, отчет из полиции или письмо из агентства по борьбе с домашним насилием) во время предложения жилья. Если вы не сможете предоставить такую документацию, любой приоритетный статус, который вы предположительно имели, исчезнет, и вы снова будете помещены в список ожидания за вычетом всех претензий на приоритет. (Теперь вы можете вернуться и завершить заявку или изменить свой ответ о домашнем насилии, если хотите, нажав «x» в верхней части экрана.)

Si vous déposez une plainte pour violence domestique, vous devrez fournir des documents (comme un rapport de police ou une lettre d'une agence de lutte contre la violence domestique) au moment de l'offre d'unité. Si vous ne pouvez pas produire ces documents, tout statut prioritaire que vous étiez présumé avoir disparaîtra et vous serez remis sur la liste d'attente moins toute demande de priorité. (Vous pouvez maintenant revenir et terminer la candidature, ou modifier votre réponse sur la violence domestique si vous le souhaitez, en cliquant sur le « x » en haut de l'écran.)

Si w reklame Vyolans Domestik, wap oblije bay dokiman (tankou yon rapò lapolis oswa yon lèt yon ajans vyolans domestik) nan moman yon òf inite w la. Si w pa kapab pwodui dokiman sa yo, nenpòt sitiyasyon priyorite w te sipoze genyen ap disparèt epi w ap mete w tounen sou lis datant la mwens nenpòt reklamasyon priyorite. (Kounye a, ou ka retounen epi fini aplikasyon an, oswa chanje repons sou Vyolans Domestik ou si w vle, lè w klike sou "x" ki anlè ekran an.)

Se denunci violenza domestica, ti verrà richiesto di fornire la documentazione (come un rapporto della polizia o una lettera di un'agenzia per la violenza domestica) al momento dell'offerta di un'unità. Se non puoi produrre tale documentazione, qualsiasi stato di priorità che presumevi avessi scomparirà e verrai reinserito nella lista d'attesa al netto di qualsiasi rivendicazione di priorità. (Ora puoi tornare e completare la domanda o modificare la risposta sulla violenza domestica, se lo desideri, facendo clic sulla "x" nella parte superiore dello schermo.)

Nếu bạn khiếu nại về Bạo lực gia đình, bạnbạn sẽ phải cung cấp tài liệu (chẳng hạn như báo cáo của cảnh sát hoặc thư từ cơ quan chống bạo lực gia đình) tại thời điểm đưa ra lời đề nghị. Nếu bạn không thể xuất trình các tài liệu đó, mọi trạng thái ưu tiên mà bạn được cho là có sẽ biến mất và bạn sẽ được đưa trở lại danh. (Bây giờ bạn có thể quay lại và hoàn thành đơn đăng ký hoặc thay đổi câu trả lời về Bạo hành Gia đình nếu muốn bằng cách nhấp vào dấu "x" ở đầu màn hình.)
.
Have you been displaced? (If YES, choose the MAIN reason)*

NoDisplaced by accessibility or health issuesDisplaced by addiction behaviorsDisplaced by cost of livingDisplaced by condemnation of home, code violationsDisplaced by domestic violence or sexual abuseDisplaced by fire, flood, earthquakeDisplaced by landlord, market forces, gentrificationDisplaced by a pandemicDisplaced by threat to life or safetyDisplaced by urban development, eminent domain
Primary Phone Number*
Secondary Phone Number (optional)
Email Address - If you provide email, you will receive confirmation of your Application in a few minutes! Check your SPAM and JUNK folders if you don't see the confirmation in your INBOX
example@example.com
Preferred Method of Contact*

EmailMailPhoneText
Where you live (or back-up mailing address if homeless). Include apt # - DO NOT WRITE "homeless" - instead, give the address of a relative, friend or social service agency)*

Address Line 1

Street Address Line 2

CityState

Zip
Dates of Current Occupancy
Is your MAILING address the same as your LIVING address?

YesNo
Best Mailing Address (can be a P.O. Box or street address - include apt # or c/o name if applicable.*

Address

Street Address Line 2

CityState

Zip
Emergency Contact Info
Name of an Emergency Contact (relative, friend, minister, etc.)

First NameLast Name
Your relationship to the Emergency Contact (relative, friend, etc)
Phone Number for the Emergency Contact
Please enter a valid phone number.
Email Address of the Emergency Contact
Complete Address of the Emergency Contact

Address Line 1 - include apartment number and c/o name, if applicable.

CityState

Zip Code
Priorities and Preferences that *may* apply to this Portfolio

Displaced by Natural DisasterDisplaced by Urban RenewalDisplaced by Health CodeDisplaced due to Domestic Violence, Sexual Assault, Stalking
Upload Document(s) that Support your Request for a Priority.

If you claim the priority, then you must upload documentation now! Examples of supporting documents: a Police Report, a letter from an agency or doctor. If you don't have the documentation ready to upload, uncheck the priority claim above. You can make the request for a priority at a later date by mailing the documentation, along with your name, SSN, DOB to the office that manages this property. Their address is at the top of this application.
Cancelof
CONTRACT:

The applicant warrants and represents that all statements herein are true and promises to execute - upon presentation - a lease in the usual form and on the terms and conditions stated therein.

The Applicant hereby grants permission to carry out necessary credit checks to verify the information contained in the application. Furthermore, the applicant understands that an investigative consumer report will be obtained which may include information about personal character and criminal records.

The Applicant agrees that the information set forth on the application is true and complete, and any misrepresentation on this application will constitute a default under the lease or Rental Agreement between the parties.

A breach of the above warranty regarding the veracity of any statements made herein releases the owner from all obligations and liabilities arising from either this agreement or a subsequent lease.

AUTHORIZATION TO PERFORM A CREDIT AND CRIMINAL INVESTIGATION

I hereby authorize Winn Management to obtain credit and criminal history information on me. I understand that this investigation will include release of information from law enforcement and judicial institutions, as well as financial institutions, credit bureaus, and public and private agencies that have relevant information on my credit and criminal history. I understand that information received through this credit record and criminal record check will be used, in part, to determine the acceptability of my rental application.

I understand that information received through this credit record and criminal record check will be used, in part, to determine the acceptability of my rental application. Should this investigation reveal adverse information, which if accurate would constitute grounds for denial of my application, I understand that I will be notified in writing prior to any adverse action being taken.

Further, I will be provided with the names, telephone numbers, and addresses of all agencies supplying such information, together with a summary of my rights under the Federal Fair Credit Reporting Act.
Signature*

Clear
STOP!!

Because you stated that you do not agree to abide by the requirements listed in the "Agreement" section at the top of this form, you will not be able to sign, or submit, this application.

Please scroll through this application, fill in the "Yes" button underneath the instructions at the top of the form - and retype any answers in the correct format if they are not in the correct format:

"Jane" - not "JANE" or "jane"

and then you will be able to sign and submit this form.
Signature of co-head or any HH member 18 and older - optional

Clear
Signature of co-head or any HH member 18 and older - optional

Clear
Signature of co-head or any HH member 18 and older - optional

Clear
If you press the Submit Button but have left some questions blank, a red error message will appear at top right. Simply click that red error message and the form will jump you right to the questions you have left blank. Provide the missing answer and then press the red error message again.
If you see the following error message when you Submit this application, click the words "See Errors". This will jump you to any questions that still need an answer.

Once you push the Submit Button, you won't be able to change any of your answers - so it is a good idea to click the tabs at the top of this application, and review all your answers before you press Submit.

If you've checked for mistakes, press the Submit button below now!
Do you need a unit that is modified to assist with a mobility, hearing or vision handicap.

YesNo
AMI Category

30% AMI ELI50% AMI VLI60% AMI80% AMI Low
Rent Categories

50% AMI VLIMore than 50% AMI
Status

Open new ApplicationUpdated and OpenClosed
Latest Outcome

Applicant with preliminary status of OPENApplicant did not complete parts of application - must re-applyApplicant must surrender voucher if housed hereApplication contained Illegible or Conflicting ResponsesApplicant requested Reasonable Accommodation - extra BR medicalIneligible due to Age at time of ApplicationIneligible due to Income or Voucher Status at time of App or VacancyIneligible due to Unit Size NeedsIneligible for other reason see NOTESInternal Transfer Request to treat as New Application
We rejected your application because:

All our waitlists are currently closed.All waitlists in your income category are closed.We don't have the size of unit you requested.We don't have the type of unit you requested.We don't have units for applicants in your income category.Some of your answers were impossible to read.You failed to complete the Application.You didn't send the required documentation.You gave an unusable birthdate.You used the wrong Application.Your Application was missing pages.You failed to Date or Sign the Application (or both).You did not provide required information on the additional HH members.You did not provide your household's TOTAL ANNUAL Income.
History and Notes
Housing Choices - You Must Select One of These Answers

Please place me anywhere I'm eligible.
Theroch Waitlists

1BR Project Based 50% AMI Federal-funded1BR Wheelchair/Handicapped 50% AMI Federal-funded2BR Project Based 50% AMI Federal-funded2BR Wheelchair/Handicapped 50% AMI Federal-funded3BR Project Based 50% AMI Federal-funded3BR Wheelchair/Handicapped 50% AMI Federal-funded4BR Project Based 50% AMI Federal-funded4BR Wheelchair/Handicapped 50% AMI Federal-funded5BR Project Based 50% AMI Federal-funded5BR Wheelchair/Handicapped 50% AMI Federal-funded
Should be Empty:

Theroch Apartments

This is A Housing Application You Can Complete with Your Cellphone or a Computer!

Agreement

Required Fields for Additional Household Members