Instructions:
SLCDC Rental Application
  • Complete this form. When finished, click the print button to the right.
  • Mail or bring this application with you to your scheduled appointment.
  • Should you have any questions, please call our office at 803-436-0020.

APPLICANT INFORMATION
Your Email Address:  
Name:  
Current Address :  
Telephone Number : Social Security: (Optional)
Date of Birth: Bedroom Size Requested:  

HOUSEHOLD INFORMATION
List below all information for each additional household member who will occupy the unit.
Name
First, Middle Initial, Last
Relationship to
head of household
M/F
Social Security
Number
Date of Birth
(Mo/Day/Yr)
M   F
M   F
M   F
M   F
M   F
M   F
Do You anticipate a change in household composition during the next 12 months? Yes     No
If Yes, explain:____________________________________________________________________

LANDLORD INFORMATION
Present Housing: Own Rent Other Monthly Amount $
Landlords' Name: First MI
Landlord's Address: city state zip
Landlord's Telephone: How Long? to
Previous Housing: Own Rent Other Monthly Amount $
Previous Address: city state zip
Landlords' Name: First MI
Landlord's Address: city state zip
Landlord's Telephone: How Long? to

Section 1 of 4

 

 

EMPLOYMENT INFORMATION

Present Employer:
Employer Address: city state zip
Occupation: Emp Dates: from to
Salary: $ per
Verification Contact Person: Fax Number:
Second/Previous Employer: Telephone Number:
Employer Address: city state zip
Occupation: Emp Dates: from to
Salary: $ per
Verification Contact Person: Fax Number:
Spouse Employer: Telephone Number:
Employer Address: city state zip
Occupation: Emp Dates: from to
Salary: $ per
Verification Contact Person: Fax Number:
 

Please list the total annual emplyment income of all members of your household
Name of Recipient
Wages
(Full Time)
Wages
(Part Time)
Overtime Pay
Commissions or Fees
Tips or Bonuses

Benefits      Please list the total benefit income for all members of the household
Name of Recipient
Social Security
(Adult)
Social Security
(Child)
Disablity or
Death Benefits
AFDC/TANF
(Welfare)
Alimony
Child Support

Section 2 of 4

 

 

 

OTHER INCOME
Does any member of the household have income from any of the following? If yes, state the amount, frequency and the household member receiving the income.

Income Type
Amount Received
Per
Household Member
Self-Owned Business
Y
N
Worker's Compensation
Y
N
Unemployed Benefits
Y
N
Serverance Pay
Y
N
Payment from Insurance Policies
Y
N
Retirement Benefits
Y
N
Pension Benefits
Y
N
Educational Grant/ Scholorship
Y
N
Veteran's Administration
Y
N
Military Reserves/National Guard
Y
N
Caretaking of Children or Elderly
Y
N
Income on Behalf of Minor Children
Y
N
Any other income
Y
N

ASSET INFORMATION      Does any member of the household own any of the following type assets
Income Type
Amount Received
Per
Household Member
Checking Account
Y
N
Savings Account
Y
N
Credit Union Savings
Y
N
Stocks / Bonds
Y
N
Treasury Bills
Y
N
Money Market Funds
Y
N
Certificate of Deposit
Y
N
Rental Property
Y
N
Real Estate/Mortgages/ Contracts
Y
N
Safe Deposit Box
Y
N
Deeds or Trust
Y
N
Annuities
Y
N
Other Financial Assets
Y
N

Section 3 of 4

 

 

 

STUDENT INFORMATION       Please provide the following information for all household members

Family Member Name
A Student Now or Next Year
Full Time
Part Time

EMERGENCY CONTACT INFORMATION       (Please provide the following information for two contacts)
Name
Address 
Phone  #
Relationship
 
Name
Address 
Phone  #
Relationship

Section 4 of 4


 

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