The Summit at Eaton Senior Communities Application Form

To meet the requirements for tenancy at The Summit, an individual must be an elderly person or family, defined as a household where the head or spouse is age 62 or older; and be a U.S. citizen or national or a non-citizen that has eligible immigration status. Income limits of 120% Area Median Income – $78,000 for a single person and $89,160 for a couple annually (2019 income limits). A refundable fee of $200 is required to hold an apartment.

A CREDIT CHECK ON EACH APPLICANT IS REQUIRED TO ASSURE ABILITY TO FULFILL FINANCIAL OBLIGATIONS UNDER THE LEASE.

THE MARITAL AND RACE INFORMATION IS VOLUNTARY AND WILL NOT BE USED FOR A DISCRIMINATORY PURPOSE. APPLICATIONS ARE MADE AVAILABLE TO INDIVIDUALS AND ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, CREED, NATIONAL ORIGIN/ANCESTRY, SEX, DISABILITY/HANDICAP, SEXUAL ORIENTATION (INCLUDING TRANSGENDER STATUS), MARITAL STATUS, FAMILIAL STATUS OR OTHER UNLAWFUL GROUNDS.

YOU MUST BE WILLING TO SIGN OUR RENTAL AGREEMENT AND ABIDE BY THE LEASE AND HOUSE RULES.

THIS APPLICATION DOES NOT PLACE LEGAL OBLIGATION OF THE APPLICANT, BUT DOES INDICATE INTEREST IN THE POSSIBILITY OF RESIDENCE IN THE SUMMIT AT EATON SENIOR COMMUNITIES. NO DEPOSIT IS NECESSARY AT THIS TIME. THE APPLICATION WILL BE REVIEWED AS APARTMENTS BECOME AVAILABLE. WHEN ELIGIBILITY OF THE APPLICANT HAS BEEN APPROVED AND THE APPLICANT DESIRES THE UNIT, A RENTAL AGREEMENT WILL BE PRESENTED FOR SIGNATURE. ALL INFORMATION CONTAINED IN THIS APPLICATION WILL BE TREATED AS CONFIDENTIAL.

Applicant Info

Name of Applicant
Email
Home Phone #
Work Phone #
Cell Phone #
List the States where household members have resided

Current Address

Current Address (with apartment #)
Name of Current Community
Dates of Occupancy
Manger's Name
Manger's Phone #

Previous Address 1

Current Address (with apartment #)
Name of Current Community
Dates of Occupancy
Manger's Name
Manger's Phone #

Previous Address 2

Current Address (with apartment #)
Name of Current Community
Dates of Occupancy
Manger's Name
Manger's Phone #

Demographic and Insurance Info

Martial Status (optional) SingleMarriedWidowed
Date of Birth
Place of Birth
Race (optional) Caucasian/WhiteAfrican American/BlackAsianNative AmericanAsian/Pacific IslanderOther
Social Security Number
Medicare Number
Supplemental Health Insurance

Personal References

Non-relative, living in this area if possible

Reference 1 Name
Reference 1 Address
Reference 1 Phone #
Reference 2 Name
Reference 2 Address
Reference 2 Phone #

Family Members

List those who are immediately available to be of support and who will respond in emergencies.

Family 1 Name
Family 1 Address
Family 1 Phone #
Family 1 relation
Family 2 Name
Family 2 Address
Family 2 Phone #
Family 2 relation

Apartment Choices

Need for Accessible Unit? YesNo
Apartment Type Studio Apartment (400 sq.ft.)1-bedroom (350-620 sq.ft.)

Sources of Income ($ monthly)

Social Security
Veterans Benefits
Old Age Pension (OAP)
Railroad Retirement Pension
Other Pension/Annuities
Supplemental Security Income (SSI)
Wages
Business Income Net
Other Supplemental Income
Other Income

Assets

Savings Account Balance
Savings Account Interest Rate
Certificates of Deposit Balance
Certificates of Deposit Interest Rate
Stocks/Bonds Value
Stocks/Bonds r/o/r
Checking account 6 month average balance
Checking account interest rate (if any)
Real estate appraisal
Amount due on mortgage (if applicable)
Rent received on property (monthly)
Other mortgage balance
Other mortgage interest rate
Personal property not included above

Applicant Questionnaire

Are you aware that The Summit is a smoke-free community, which means that The Summit does not allow smoking or use of tobacco products of any kind by residents, visitors, and employees anywhere inside the building, including resident apartments other than special designated areas? YesNo
Have you ever been evicted or involuntarily removed from any housing or residential situation? YesNo
If yes, please explain
Have you been convicted of a crime, other than a traffic violation, within the last 5 years? YesNo
If yes, please explain
Do you have a pet? YesNo
Do you have a car? YesNo
Are you or any members of your household subject of a lifetime registration requirement under any state sex offender registration program? YesNo
If yes, please explain
Applicant 1 name (constitutes signature)
Applicant 2 name (constitutes signature)
Date of Application