Wellington Village Senior Apartments
Wellington Village Senior Apartments
Wellington Village Senior Apartments.
Wellington Village Senior Apartments.

Part I: Applicant Information Name:_______________________________________________ Address:__________________________________________________

Street __________________________________City_______________ State_____________________ Zip______________________

Own Home Live w/relatives
Rent Home Monthly payment:__________________
Home phone:__________________
Date of Birth:_____________________
Social Security Number:___________________
Employed ___Yes ____No
Part 2:Co-Applicant Information



Street ________________________________City_____________________

State_____________________________ Zip____________________
Own home
Live w/relatives
Rent home Monthly payment:__________
Date of Birth:___________________
Social Security Number:________________
Employed:______Yes ____No
Part 3: Employment History (only if applicable)
Name of Employer:______________________________ Position:______________ Hire Date:__________________________ Hours per week:___________________
Salary: $______________________ per hour week bi-week month year
Part 4: Eligibility
Is the head of household a full time student?  Yes  No
Are all members of your household full time students?  Yes  No
Do you/occupants receive food stamps? Yes  No
Are you receiving governmental housing assistance? Yes  No
Have you/occupant(s) been arrested for illegal acts?  Yes  No
Do you require a live-in attendant? Yes  No
Part 5: Income verification(s):
Forms of income other than employment, please check all that apply.
Social Security
Retirement Plan(s)
Self- Employment
Alimony/Child Support
Unemployment compensation
Workman’s Compensation
Government Assistance
Part 6: Asset Verification(s):
Please check all that apply
Checking Account
Savings Account
IRA (Individual Retirement Account
CD (Certificate of Deposit)
Money Market Accounts
401K Plan(s)
Treasury Bills
Life Insurance
House/Rental Property
Cash on Hand
Part 7: Household Composition We certify that the individuals listed below comprise the household of this application. Please list all members of your household including yourself. Name, Date of Birth, Social Security #, and Relationship
Emergency Contact Information: Name:__________________________________ Relationship:__________________
Home phone:______________________
Cell Phone:_________________________
Thank you for your interest in living at Wellington Village. Because we are served by the Tax Credit Program administered by the Federal Governemtn of the United States, we will need to collect additional information and verifications before we can allow you to move into our community. By signing this application, you agree to allow us to contact a credit -reporting agency to access your credit/police record(s) and obtain any other verification’s necessary to approve your application. I/We certify that the information listed herein is true and accurate to the best of my knowledge. Should I/We be accepted as a resident(s), this information will be considered an addendum to the lease agreement. If any information on this application is determined to be falsified, this application will automatically be declined. Wellington Village has a zero tolerance policy with regard to drug-related activities and violent behavior.
If you would have questions regarding the application, please feel free to contact the Managers office at 614- 777-8553 during regular office hours.
Printed Name ________________________________

Signature__________________________________ Date_________________

Printed Name ______________________________________
Signature ______________________________________ Date ________________________________
One bedroom ____________
Two bedroom____________
Date received:_____________
Time received:_____________ Agent:___________________

Contact Us Today!

Wellington Village Senior
5863 Scioto Darby Road
Hilliard, Ohio  43026

Phone: 614-777-8553

E-mail:  wellington@bethel94.com

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