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Masala Community Housing Rental Application

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Housing Rental Application
This information will be used to determine your qualification for tenancy in Masala Community Housing. This information is CONFIDENTAL and will not be disclosed to anyone except the members of Masala Co-op, Boulder Housing Coalition staff, and the city of Boulder/HUD (for the purpose of verification of income and general affordable housing data only). You are not required to provide this information, but without it, your tenancy application may be delayed or rejected. Any false statements given on this Rental Application are grounds for the rejection of your tenancy application.
Fair Housing Statement:

The Boulder Housing Coalition and Masala Community Housing are equal opportunity housing providers. The BHC and Masala abide by the City of Boulder Prohibition of Discrimination in Housing Statement, as presented in ordinance #4571. The BHC and Masala will not deny housing to any individual because of race, creed, color, sex, sexual orientation, gender variance, marital status, religion, national origin, ancestry, pregnancy, parenthood, custody of a minor child, or mental or physical disability of that individual, or such individual's friends or associates.

Date of Application: _________ Anticipated Move in Date: __________

Applicant’s full name:____________________________________________________________

Mailing Address:_________________________________________________________________

City State Zip Code

Phone: (H) __________________ (W) ___________________ (Mobile) ___________________
Drivers’ License/ State ID #: ____________________________Email Address:________________________________________
Birth date: Month _____ Day _______ Year _______ Social Security #: ______ - ____ - ______

How long at present address? __________ Current monthly rent: _____________________

Current Landlord (Name): __________________________ Company: _____________________
Mailing Address: _________________________________ Phone: ________________________

Previous Landlord (Name): __________________________ Company: ____________________

Mailing Address: ____________________________________ Phone: _________________
Your Address There: _________________________________________________________

Emergency Contact Name: ___________________________ Phone: ______________________

Address: __________________________________________ Relationship:_________________

General Information:

Non-Student:______ Part-Time Student:______ Full Time: Student:_____ Grad Student_____

The Masala Cooperative is a permanently affordable rental property and residents are required to income qualify. Annual income can't exceed 10% above the HUD low-income limit (currently $51,200) and assets can not exceed limits set by the city of Boulder (currently $50,000). After occupancy, tenants may be allowed to renew their leases until their incomes exceed thirty (30%) more than the HUD low-income limit (currently $58,240).
Do you have income or assets that exceed the above amounts? (Answering ‘yes’ will not automatically disqualify you from living at Masala).
Occupation:__________________________________ How long have you worked in Boulder?________________
How many hours do you work a week?_______ Annual Income:____________ How long have you lived in Boulder?_________
Do you own an animal? How many/what kind? ______________________
Do you owe any unpaid rent? _________Have you ever been evicted from a place of rental? ________. If yes, why?
Have you ever been convicted of a felony? If yes, explain:
Would you consent to a background check?______________
Get to Know You Questions: Please feel free to attach extra paper if you need more room.

Please tell us about yourself and your interests.

Do you have any special needs? or Do you require any special accommodations? If so, what type?

Do you have any special food preferences or allergies?

What does community mean to you?

Do you have any previous co-op or group living experience? Please explain.

How did you hear about Masala?

Why do you want to live at Masala?

What skills/experience can you contribute to the Masala community? (e.g. gardening, cooking, management)

What difficulties do you think you may have living in the Masala community?

Are you willing and able to do 6 hours a week of work shifts/chores?
I understand that as a member of Masala, I will be responsible for attendance & participation at house meetings; participating in the chore system as explained in the Membership Manual; and paying my agreed rent by the agreed time. I also understand that should I be accepted into the Masala Co-op this application will become part of my lease with Masala Community Housing. Misrepresentations in the application shall be considered as cause to terminate the lease.
I herby certify that the information provided above is true and complete to the best of my knowledge and belief.
Applicant Signature:_____________________________________ Date__________________

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