Management Company ROHLFFS MANOR 2400 Fair Drive Napa, CA 94558 Phone: 707.255.9555 Fax: 707.255.9577 TDD: 1.800.735.2929 CalBRE Lic #00853485 HI Lic. RB-16985 WAITING LIST INSTRUCTIONS 1. Submit 1 application per household 2. All adult applicants must sign their own Consent and Release f01m 3. All adult applicants must provide a copy of thier photo ID and signed social security card 4. Application Fee per applicant ($25 cashier's check/money order only) PLEASE DO NOT SUBMIT ANY ADDITIONAL DOCUMENTS WITH YOUR APPLICATION. All income and assets documents will be requested once a unit has been offered to you. APPLICATION INSTRUCTIONS All applications must be filled out in either blue/black ink or typed. (MUST BE LEGIBLE) All questions must be answered. If the questions do not pretain to the applicant, please check the "NI A" box. If there is no box is provided please write "N/ A" e NO WHITE-OUT. All applications with evidence of white-out will be sent back. If applicants make a mistake, draw a line through the mistake and initial next to it e Applicants must provide at least 2 years of landlord reference Application must be signed e Applicants must indicate on application their monthly income e Only provide current information NOTE: All applications not filled out correctly will be sent back ALL APPLICANTS MUST MEET THE FOLLOWING TO QUALIFY: e Age requirements for units must be met e State -Head of Household must be 55 years old Federal-Head of Household must be 62 years old For all 2 bedroom apartments, their must be 2 applicants applying and Head of Household must be 62 years old Income qualify -please refer to our current rate sheet Minimum income -month household income must be twice the rent of unit applying for Must have 1 st month rent, security deposit ( equal to l months rent). & key deposit ($10/per set) on or before scheduled move in date 111 For additonal qualification requirements, please refer to Rohlffs Manor's Resident Selection Plan EQUAL HOUSING OPPORTUNITY It is the policy of EAH, Inc. not to discriminate against any person because of that person's race, color, religious creed, sex (gender), sexual orientation, marital status, national origin, ancestry, familial status (households with children under the age of 18), source of income, disability, medical condition or age. - OPPOATUNIH
EaU!Zl HOUSHHi OPPORTUN! r i 2400 FAIR DR. NAPA, CA 94558 OFFICE: (707) 255-9555 FAX: (707) 255-9577 CalBRE Lic. #00853485 HI Lic. RB-16985 To be considered for residency at Rohlffs Manor, either, your maximum household income cannot exceed $36,720 for one person and for two persons, the requirements set by the U.S. Department of Housing and Urban Development (HUD). Please refer to the Resident Selection Plan for minimum income standards. ROHLFFS MANOR (General) Rohlffs Manor rent includes: water and garbage State Studio... $510/$641 (50%/60% of AMI) State One Bedroom... $770/$934 (50%/60% of AMI) Federal Studio... $563.00 Federal One Bedroom... $632.00 Two Bedroom... $825.00 ROHLFFS MANOR (Building C) Concordia rellt includes: electricity, water and garbage State Studio... $510/$641 (50%/60% of AMI) State One Bedroom... $770/$934 (50%/60% of AMI) Federal Studio... $668.00 Federal One Bedroom... $674.00 All prices above subject to availability. Rates may change at any time without notice. Share:\Forms 1/1/14 EQUAL HOUSING OPPORTUNITY EAH Rohlffs Manor, LP does not discriminate on the basis of handicapped status in the admission or access to, or treatment or employment in, its federally assisted programs or activities.
EAH Application for Housing ROHLFFS MANOR 2400 FAIR DRIVE 0 NAPA, CA 94558 TELEPHONE (707) 255-9555 CalBRE Lic. #00853485 HI Lic. RB-16985 Revision Date: 6/29/2016 62016HUOS8 EAH Property Management Use Only APPLICATION APPROVED: Yes O No 0 BEDROOM SIZE TIME OF APPLICATION: COMMENTS BARRIER FREE (H/C) YES ONO 0 DATE OF APPLICATION: UNIT REQUESTED? APPLICATION RECEIVED BY: APPLICATION#: LOTIERY#: PLEASE NOTE: The information you provide on this application will be treated as confidential. It Includes both Information necessary for determining your eligibility for housing, and information required for statistical purposes. The race, ethnicity, and gender Information Is requested In order to assure the Federal laws prohibiting discrimination against applicants are complied with. You are not required to furnish this Information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. Please answer each question as completely as possible. Any information found to be incomplete and/or falsified will cause the application to be denied and not processed. Please complete the following application and return it to the Property. All Items must be complete in order to determine your eligibility. If an item does not apply to you, please check N/ A next to the question. EAH does not discriminate on the basis of race, color, sex, gender Identity, marital or domestic partner status, sexual preference, familial status, national origin, ancestry, age, physlcal disablllty. Acquired Immune Deficiency Syndrome (AIDS) or HIV status in the leasing, rental, or other disposition of housing or related facilities. Number of bedrooms requested st Request: 2" Request: A. GENERAL INFORMATION: HEAD OF HOUSEHOLD CO-HEAD Check If N/ A D Name: Name: Home phone: Home phone: Cell Phone Cell Phone Work Phone: Work Phone: Emall: Email: B. HOUSEHOLD COMPOSITION List all persons, including yourself, who will be living In the apartment. list the head of household first. Do not Include minors who wlll reside In the unit less than 50% of the time. Name Relationship Date of Race Ethnicity Citizenship Gender Full Social First/last To HEAD of Birth Whlte/Ciucaslan Enter one - Enter Time Security/ Household mm/dd/yy Black/ African-Amer. Hlspanlc of the "Male" Q! Studen TIN* (HOH) Aslan Non- following: ''Female'' Am. Indian/AK Native Hispanic ty/n (last four.q! Hawallan/Paclflc Is. (K-12/ only) Citizen Leave Other Leave College) 5555 Immigrant blank If - blank If vou Leave blank If vou vouwlsh Refugee choose wish not to report not to Green Card not to report Visa Holder respond 1. 2. 3. HEAD CO-HEAD /Spouse For those applicants without a Social Security Number, do you qualify for one of the three allowable exceptions? D Check if N/ A YES0No0 1) Ineligible, non-citizen member - not contending eligible immigration status. Household members name: YES0N00 2) Members that were 62 years old as of January 31, 2010 and whose initial determination of eligibility began before January 31, 2010. Household members name: YES0No0 3) Members under the age of 6 eligible for a 90-day extension to provide their SSN, if added to the household within the last 6 months Household members name: Input Property Phone Number/Property Fax Number TTY: (800) 735-2929 TDD (800) 545-1833 ext 482 Pagel, OPHllU!lffl
ROHLFFS CONCORDIA MANOR 2400 FAIR DRIVE, NAPA CA. 94558 TELEPHONE (707) 255-9555 TDD (800) 735-2929 RCM-MANAGEMENT@EAHHOUSING.ORG CalBRE Lic. #00853485 HI Lic. RB-16985 RESIDENT SELECTION PLAN Rohlffs Concordia Manor is a 355 unit ( 46 units are set-aside for project-based Section 8), Tax Credit and RHCP senior community in Napa, California that provides housing for low, very low and extremely low income seniors, without regard to race, color, sex, creed, religion, national origin, physical or mental disability status, familial status, age, ancestry, marital status, source of income, sexual orientation, gender identity, or any other arbitrary personal characteristics. Rohlffs Concordia Manor operates under the following financed programs: Tax Credit program (all 355 units) o Section 202 program (100 units with 16 project-based Section 8 units) @ Section 236 program ( 46 units with 30 project-based Section 8 units) Rental Housing Construction Program (RHCP) (177 units) SECTION 504 AND FAIR HOUSING ACT COMPLIANCE Rohlffs Concordia Manor is an Equal Opportunity Housing Facility, admitting people in accordance with Local, State and Federal Fair Housing laws, HUD Section 202, HUD Section 8 Progran1 Regulations, the Affirmative Fair Housing and Marketing Plan (AFHMP) HUD Forn1 935.2, the State of California's Tax Credit Allocation Committee (CTCAC) and RHCP program regulations. All marketing, tenant selection and residential management policies and procedures shall be conducted in accordance with these laws. Management staff operates and administers the property to enable persons with disabilities to have equal access to participate in the program. Rohlffs Concordia Manor will ensure effective communications with applicants, residents, and the public to ensure that policies regarding how the property is operated do not adversely affect applicants, residents and the public. When a family member requires an accessible feature(s ), policy modification, or other reasonable accommodation to accommodate a disability, Rohlffs Concordia Manor will provide the requested accommodation unless doing so would result in a fundamental alteration in the nature of the program or an undue financial and administrative burden. A reasonable accommodation is a change, exception, or adjustment to a program, service, building or dwelling unit that will allow a qualified person with a disability to: 1. Participate fully in a program; 2. Take advantage of a service; or 3. Live in a dwelling. Section 504 of the Rehabilitation Act of 1973 prohibits discrimination on the basis of disability in any program or activity receiving federal financial assistance from HUD. The Fair Housing Act prohibits discrimination in housing and housing related transactions based on race, color, religion, sex, national origin, disability and familial status. Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color or national origin in any program or activity receiving federal financial assistance from HUD. To show that a requested accommodation may be necessary, there must be an identifiable relationship, or nexus, between the requested accommodation and the individual's disability. The requirement to provide a reasonable accommodation is present at all times throughout the tenancy of a person with disabilities, including during lease enforcement. Reasonable Accommodation Request forms are available upon request from management. Rohlffs Concordia Manor RSP 7/18/2016 1
the internal resident waiting list and in the case that no existing resident qualifies for or is interested in the Section 8 program, secondly, fills the Section 8 vacancies from the applicant waiting list. To be eligible for the internal waitlist, you must be an existing resident of Rohlffs Concordia Manor. Section 8 vacancies; whether from the internal or external waiting list will be filled in accordance with the preferences section of this plan. Residents on the internal waiting list must meet the eligibility criteria for the Section 8 program at the time of the initial interview to determine eligibility. EQUAL HOUSING OPPORTUNITY Rohlffs Concordia Manor does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally-assisted programs and activities. EAH INC. A NONPROFIT HOUSING CORPORATION CalBRE Lic. #00853485 HI Lic. RB-16985 Since 1968 Creating Community by Developing, Managing and Promoting Quality Affordable Housing E OPPORTUNITY Rohlffs Concordia Manor RSP 7/18/2016 10
CalBRE Lic. #00853485 HI Lic. RB-16985