Beyond Housing:housing-rental-form

This form is NOT an application for housing. Fields marked with an asterisk * must be completed.

In order for your eligibility to be considered, you MUST:

have a minimum gross (before taxes) income of $1,725.00 (not including food stamps) per month for the entire household... if you have a Section 8 voucher, the minimum monthly income is $700.00;
be able to establish utility services in your name with no outstanding balance from prior service on your account;
have no pets (except for service/assistance animals).

Please allow 10-15 business days to determine your eligibility.

Rental Housing Eligibility Form

First Name

Last Name

Date of Birth

Home Phone

Work Phone

Cell Phone

Email

Confirm Email

Street Address

Address Line 2

City

State/Province/Region

Postal/Zip Code

Country

Are You From St. Louis?

Yes

No

Are You Currently Homeless?

Yes

No

Do You Currently...

Own a Home?

Rent A Home?

Live with Family?

Live with Friends?

Do You Own a Car?

Yes

No

Do You Have Any Pets? If YES, do not submit this form unless your pet is a service/assistance animal.

Yes

No

Why Do You Want to Move?

Household Member 1

Enter information about other members of your household here.

First Name

Last Name

Gender

Male

Female

Date of Birth

Relationship to You

Household Member 2

Enter information about other members of your household here.

First Name

Last Name

Gender

Male

Female

Date of Birth

Relationship to You

Household Member 3

Enter information about other members of your household here.

First Name

Last Name

Gender

Male

Female

Date of Birth

Relationship to You

Household Member 4

Enter information about other members of your household here.

First Name

Last Name

Gender

Male

Female

Date of Birth

Relationship to You

Household Member 5

Enter information about other members of your household here.

First Name

Last Name

Gender

Male

Female

Date of Birth

Relationship to You

Household Member 6

Enter information about other members of your household here.

First Name

Last Name

Gender

Male

Female

Date of Birth

Relationship to You

Household Member 7

Enter information about other members of your household here.

First Name

Last Name

Gender

Male

Female

Date of Birth

Relationship to You

Household Income

You must have a minimum gross (before taxes) income (not including food stamps) of $1,725.00 per month for the entire household. If you have a Section 8 voucher, the minimum monthly income is $700.00. Please do not submit this form if you do not meet these conditions.

Employment Status

Full Time

Part Time

Unemployed

Total Monthly Household Income (not including food stamps.)

If you receive food stamps, how much per month?

Do you have a housing subsidy?

Yes

No

Rental and Utility Payments

Your inquiry will not be considered if you have an outstanding rental balance in excess of $1,000.00 or if you have any outstanding balance due to a utility service provider that prevents you from establishing new service in your name. Please do not submit this form if you do not meet this condition.

If you pay rent to a landlord, family member, or friend, what is your monthly rent rate?

If you are renting, are your rental payments up to date?

Yes

No

If your rental payments are not up to date, what is the dollar amount past due for rent?

If you are renting, when is your lease due to expire?

Ameren UE

Payments are up to date

Payments are past due

If past due, what is the amount owed to Ameren UE?

Laclede Gas

Payments are up to date

Payments are past due

If past due, what is the amount owed to Laclede Gas?

Telephone Company

Payments are up to date

Payments are past due

If past due, what is the amount owed to Telephone Company?

Water Department

Payments are up to date

Payments are past due

If past due, what is the amount owed to Water Department?

More About You

More information about you

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Rental Housing Eligibility Form

Household Member 1

Household Member 2

Household Member 3

Household Member 4

Household Member 5

Household Member 6

Household Member 7

Household Income

Rental and Utility Payments

More About You