APARTMENT APPLICATION

Print this application on legal size paper, complete and mail it with the application fee to the Riverbay Residential Sales Department, 2057A Bartow Avenue, Bronx, NY 10475. To submit electronically, type in all requested information below and sign the certification before submitting. All applications must be accompanied by the $75 application fee or else the application will be deemed incomplete. Payment can be made by check, money order.

Original application will be time and date stamped upon receipt and entered into NYS Homes and Community Renewal’s Automated Waiting List (AWL) in chronological order. Applicant will be contacted with or emailed (if electronic submission) a print out of the AWL summary with application number. Applicants can monitor waiting list position and update their contact information using the AWL’s public access function @www.nyshcr.org.

Applicant Address:

Head of Household:(Must be completed. Head of household must be 18 years of age or older.)

Co-Head of Household:(Complete if applicable. Co-head must be 18 years of age or older.)

Other Household Members:(List all other persons who will reside in apartment.)

Apartment Size:(Select one or two sizes. Household must meet applicable occupancy standards.)

 
 
 
 
 
 
 

Special Requirements:(Note that special requirements can extend your wait for an apartment.)

Gross Household Income
$

Enter total adjusted gross income reported on the federal income tax returns for the prior calendar year for all household members, less $1,000 for each personal and dependent exemption, and less $20,000, or actual earnings if less, for each secondary wage earner

The 4.0, 5.0, and 6.5 room apartments have terraces. The 3.0, 3.5 and 4.0 room apartments have one‐bedroom. The 4.5 and 5.0 room apartments have two‐bedrooms and the 6.0 and 6.5 room apartments have three‐bedrooms.

  • Have you, your co-applicant or any family members living with you ever been criminally convicted for producing methamphetamine? Yes No
  • Is the applicant, co-applicant or any proposed occupant required to be a lifetime registrant on a state sex offender registry? Yes No If you answered “no” to questions 1 & 2, please answer question 3:
  • Have you, your co-applicant or proposed occupant ever been convicted or arrested for a crime affecting the health, safety and/or welfare of others, but for which the outcome is still pending? Yes No
  • If you answered “yes” to questions 1 through 3 above, please answer the following: Period of time that has elapsed since the criminal conviction(S) or arrest(S) for which the outcome(S) is/are still pending:

    Age of the convicted person at the time of his/her conviction(s):

    Describe the acts or acts which were the basis of the conviction or arrest, for which the outcome is still pending:

    Provide any information/documentation that can be produced on behalf of the proposed occupant, describing rehabilitation and good conduct, including, but not limited to, evidence of completion of treatment, rehabilitative programming, history of employment and tenancy, volunteer or community activity, and letters of reference from employers, landlord, community member or others specifically addressing the person’s conduct since their conviction(s).

  • Have any children living with you ever been expelled from school? Yes No If yes, please explain:
  • Does any child(ren) living with you have youthful offender status? Yes No
  • Do you, your co-applicant or any family members living with you presently use illegal drugs or abuse alcohol? Yes No
  • Have you or your co-applicant ever been evicted from an apartment for any reason? Yes No

    If you answered “yes” to questions 4 through 7, this is not an automatic disqualification.

    Please provide a description of the facts for each “yes” Answer:

  • Are you a veteran? Yes No

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