Apply Now - The Heights Darien

First Name*

Last Name*

Email*

Address*

City*

State*

Zip Code*

Home Phone

Cell Phone*

Household Composition: Please indicate head(s) of the household and describe the relationship of the others to the Head(s) of the household.

For example: Mary Jones – 55 – F – N, John Jones – 16 – M – son, Sally Smith – 12 – F – daughter. You are not required to indicate any person’s age. For the head(s) of the household only, please indicate if that person is a full-time student.

Head of Household - 1*

Age*

Sex

Full-time student?

Head of Household - 2

Age

Sex

Full-time student?

Members of Household - 1

Age

Sex

Relationship to head(s)

Members of Household - 2

Age

Sex

Relationship to head(s)

Members of Household - 3

Age

Sex

Relationship to head(s)

Members of Household - 4

Age

Sex

Relationship to head(s)

Annual Income and Assets:
For each member of the household, please list the anticipated annual income (income from any and all sources including income from wages, benefits, child support, alimony and income from assets). Also, please list total assets for each member of the household (for assets held jointly, list them under one member’s name). Assets include cash on hand, bank accounts, stocks, bonds, and real estate.

Name - 1*

Annual Income*

Assets

Name - 2

Annual Income

Assets

Name - 3

Annual Income

Assets

Name - 4

Annual Income

Assets

Does your household require a handicapped accessible unit (one which can accommodate a wheelchair)?

Yes
No

Does your household require a handicapped adaptable unit (one which has no stairs)?

Yes
No

How many bedrooms does your household require? Please note that unless there are special needs, single-person households and couples be housed in a 1-bedroom apartment.

1 bedroom
2 bedrooms
3 bedrooms

Race/Ethnic Data (your response is not required but is appreciated). Please indicate the race/ethnicity of the head(s) of the household.

American Indian or Alaskan Native
Asian/Pacific Islander
Black/African American (not of Hispanic origin)
White
Hispanic

I understand that this document is a Preliminary Application for The Heights at Darien. Furthermore, I understand that if I am selected for an apartment, I will need to file a formal application and will need to provide verification of household composition, income and assets as well as consent to a criminal background check, a credit check and a prior landlord check. I understand that results of the verifications and checks may eliminate me from consideration for tenancy. I understand no smoking is allowed in any apartment or building at The Heights at Darien.

Consent*

I understand and agree.

Your Name

Date