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Online Pre-Application Form (Laurel)

Online Pre-Application for Laurel at Perennial Park

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Step 1 of 4

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Property Name

Current Open Listed Properties*

Please select the property name you are applying for.

I am a former resident of the Journey's End Mobile Home Park displaced by the 2017 Tubbs Fire*

Yes

Name (Head of Household)*

First Name Last Name

Address*

Street Address City State Zip Code

Daytime Phone Number

Evening Phone Number

Cell Phone Number

Email Address

Email is a great way to communicate with me! Please send me future notification of future vacancies and projects.

Opt in to receive text messages of future vacancies and projects

Member of Household (Begin with your name)

Name

Relationship to HOH

DOB (mm/dd/yyyy)

Gender (M/F/Others)

Monthly Gross income

Click on the + sign in the circle to the left of Monthly Gross Income box to add more household member.

Total Monthly Household Income*

Does anyone in your household fall under this catergory?

Hold a section 8 voucher

Employed as an agricultural worker/farm laborer

Disabled

Veteran

Does the member require a downstairs unit?

YES

Please read and sign below.*

I agree to the privacy policy.

Certification: I declare under penalty of perjury under the laws of the State of California that the information contained in this Preliminary. Application is given voluntarily and is true and correct. I understand that the answers are subject to verification.

Household Member Signature*

Please don't forget to sign before you submit the application.

Date*

YYYY

Affirmative Fair Housing

To help us assess affirmative fair housing effectiveness, please check the category that best describe your race/ethnicity. This information is strictly voluntary on your part.

Race Categories (Single Race)

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pac islander

White

Two or More Races

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pac islander

White

Ethnicity Category (Hispanic or Latino)

Mexican/Chicano

Puerto Rican

Cuban

Other Hispanic/Latino

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Burbank Housing Development Corporation, Licensed by the California DRE #01154604, NMLS #367236
Burbank Housing Management Corporation, Licensed by the California DRE #01197401

For general information regarding our housing, please contact info@burbankhousing.org or call (707) 526-9782. Burbank Housing Development Corporation and Burbank Housing Management Corporation do not discriminate in admission or access to, or treatment during access in, housing or employment opportunities towards any person because of that person’s race, color, religious creed, sex (gender), sexual orientation, marital status, nationality origin, ancestry, familial status, source of income, disability status, medical condition, or age. Burbank Housing has designated a person to coordinate compliance with its nondiscrimination requirements who can be contacted as follows: Mail: Burbank Housing Main Office, addressed to Burbank Housing, Attn: 504 Coordinator Telephone: (707) 681-0628 or TTY (877) 735-2929 Email: 504coordinator@burbankhousing.org.