Application – Colonia Libertad

Please contact management for any questions regarding eligibility. To qualify for our housing, you must fill out the application below, or call to schedule an appointment.

Colonia Libertad Community

1 - 4 bedrooms in Salem, OR, (503) 315-2288 or at anagomez@evolvemanagement.org

Property Name you are applying for*

We want to confirm. See property name above.
Applicant Name*
Applicant Email*
Applicant Phone*
Alternative Number
Your Address*
Street Address City State / Province / Region ZIP / Postal Code
Preference Bedroom Units*
- 1BD
- 2BD
- 3BD
- Others
Household Composition*
Name Age Relation to head of house Date of birth M/F Social security # (Conditional)

Click + sign for adding more members
Do you anticipate any changes to your household size in the next 12 months?*
- yes
- no
If you answered YES (Explain)
Rental History (prior 3 years)
Current Address*
Street Address City State / Province / Region ZIP / Postal Code
Move In Date*
MM slash DD slash YYYY
Move Out Date*
MM slash DD slash YYYY
Landlord Name*
Landlord Phone #*
Monthly Rent*
Previous Address
Street Address City State / Province / Region ZIP / Postal Code
Move In Date
MM slash DD slash YYYY
Move Out Date
MM slash DD slash YYYY
Landlord Name
Landlord Phone #
Monthly Rent
Least Previous Address
Street Address City State / Province / Region ZIP / Postal Code
Move In Date
MM slash DD slash YYYY
Move Out Date
MM slash DD slash YYYY
Landlord Name
Landlord Phone #
Monthly Rent
Unit Size Required
- 1-3 Persons | 1 Bedroom
- 2-5 Persons | 2 Bedrooms
- 4-7 Persons | 3 Bedrooms
- 8-9 Persons | 4 Bedrooms
What is your housing situation?
- Homeless
- Recovering from Abuse
- Living w/another family
- Recovering from Domestic Violence
- Living in a Labor Camp
- Paying HIGH Rent
Total Income of all Household Members:
SOURCES OF INCOME INCULDE BUT NOT LIMITED TO: Welfare, Social Security, SSI, Pension, Disability, Compensation, Unemployment, Interest, Child Care, Caretaking, Alimony, Child Support, Annuities Dividends, Income from Real Property, Armed Forces Reserves, Scholarships and/or Grants, Wages form odd jobs including seasonal jobs.
click + for more columns*
Name Wages/Salary Other Sources/temporary jobs $$$ Annual X $$$ Monthly X No. of Months on the job Name of Employer
Total Income from above table*
1. Have you or any member of your household previously rented from Evolve Property Management?
- yes
- no
If yes, please indicate the month/year
2. Have you or any member of your household ever been evicted?*
- yes
- no
If yes, please explain.
3. Do you or a member of your household require a Handicap unit?
- yes
- no
If yes, what features or auxiliary aids do you require
5. Have you or any person who will occupy the unit ever been convicted, plead guilty, no-contest or have current pending charges to any felony or misdemeanor?*
- yes
- no
6. Are you or any person who will occupy the unit a registered sex offender?*
- yes
- no
If Yes, Date and location of registration:
7. Do you have Assets such as: Checking/Savings Account, including Real Property, Stocks, Bond.*
- No ( assets in or outside of US )
- Yes ( I do have assets Exceeding $5,000)
Please list the value of the total amount of assets*
8. Do you or a member of your household require a disability adjustment to your income?
- No
- Yes (Disability must be verified)
Number of Dependents
IS Head of household or spouse 62 or over?*
- Yes
- No
If yes, do you receive social security benefits?
- No
- Yes
$$$
9. DO you or a member of your household require a childcare adjustment to your income?
- No
- Yes (Must be Verified)
Number of Dependents
If yes, please indicate the amount? $
Applicant Name*
Date*
MM slash DD slash YYYY
Agent for Owner
Date
MM slash DD slash YYYY
The information regarding race, ethnicity, and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service that the Federal Laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age, and disability are complied with. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity, and sex of individual applicants on the basis of visual observation or surname.
Ethnicity
- Hispanic or Latino
- Not Hispanic or Latino
Race
- American Indian/Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific islander
- White
Gender
- Male
- Female

roulette 222

Name	Age	Relation to head of house	Date of birth	M/F	Social security # (Conditional)

Name	Wages/Salary	Other Sources/temporary jobs	$$$ Annual X	$$$ Monthly X	No. of Months on the job	Name of Employer

Colonia Libertad Community

Rental History (prior 3 years)

Total Income of all Household Members: