Application for Housing Assistance
Application for Housing Assistance To be considered for housing assistance, you will need to fill out the following form in its entirety and attach a copy of your most recent Social Security/Canada Pension statement. If awarded housing assistance, monthly payments will be paid directly to the retirement facility. Housing assistance must be requested and approved annually. Applicants must be at least age 55 in order to qualify. Information:
(must complete)
Name ________________________________________________________________ IAAP Membership Identification Number __________________________ Address ______________________________________________________________________________________________________________________________ City ____________________________________________________________ State _____________________________ Zip/PC __________________________ Date of Birth _____________________________________ Social Security Number ______________________________________________________________ E-mail ________________________________________ Telephone __________________________________ Fax ______________________________________ Retirement Community ________________________________________________ Manager _______________________________________________________ Address ______________________________________________________________________________________________________________________________ City ____________________________________________________________ State _____________________________ Zip/PC __________________________ E-mail ________________________________________ Telephone __________________________________ Fax ______________________________________
Monthly Income and Expenses
Income
Wages Social Security/Canada Pension Other Pension(s) Annuities Interest & Dividends Other Assistance Miscellaneous Income
$
Statement of Net Worth Assets
Cash and Checking Certificates of Deposit Other Investments Real Estate Automobile Life Insurance Value Other Assets
Total Income Expense
$
Total Assets Liabilities
Rent
Automobile Loan Life Insurance Loan All Other
Total Liabilities
* Net Worth = Total Assets – Total Liabilities
Tel
Net Worth*
10502 N Ambassador Dr., Suite #100 • Kansas City MO 64153-1291 816-891-6600 • Fax 816-891-9118 • E-mail [email protected] • Website www.iaap-foundation.org
If you are not a current IAAP member, were you a member previously? q Yes
q No
Administrative Experience & History (resumes will not be accepted in lieu of form)
Company Name/Contact Name/ Phone Number
Years Employed (mm/yy-mm/yy)
Job title
Job Responsibilities
I certify these statements are true to the best of my knowledge. (An electronic signature is acceptable).
_____________________________________________________________ Signature
____________________ Date
Please attach a copy of your most recent Social Security/Canada Pension statement, award letter and/or tax return and mail to:
Tel
10502 N Ambassador Dr., Suite #100 • Kansas City MO 64153-1291 816-891-6600 • Fax 816-891-9118 • E-mail [email protected] • Website www.iaap-foundation.org
(must complete)
Name ________________________________________________________________ IAAP Membership Identification Number __________________________ Address ______________________________________________________________________________________________________________________________ City ____________________________________________________________ State _____________________________ Zip/PC __________________________ Date of Birth _____________________________________ Social Security Number ______________________________________________________________ E-mail ________________________________________ Telephone __________________________________ Fax ______________________________________ Retirement Community ________________________________________________ Manager _______________________________________________________ Address ______________________________________________________________________________________________________________________________ City ____________________________________________________________ State _____________________________ Zip/PC __________________________ E-mail ________________________________________ Telephone __________________________________ Fax ______________________________________
Monthly Income and Expenses
Income
Wages Social Security/Canada Pension Other Pension(s) Annuities Interest & Dividends Other Assistance Miscellaneous Income
$
Statement of Net Worth Assets
Cash and Checking Certificates of Deposit Other Investments Real Estate Automobile Life Insurance Value Other Assets
Total Income Expense
$
Total Assets Liabilities
Rent
Automobile Loan Life Insurance Loan All Other
Total Liabilities
* Net Worth = Total Assets – Total Liabilities
Tel
Net Worth*
10502 N Ambassador Dr., Suite #100 • Kansas City MO 64153-1291 816-891-6600 • Fax 816-891-9118 • E-mail [email protected] • Website www.iaap-foundation.org
If you are not a current IAAP member, were you a member previously? q Yes
q No
Administrative Experience & History (resumes will not be accepted in lieu of form)
Company Name/Contact Name/ Phone Number
Years Employed (mm/yy-mm/yy)
Job title
Job Responsibilities
I certify these statements are true to the best of my knowledge. (An electronic signature is acceptable).
_____________________________________________________________ Signature
____________________ Date
Please attach a copy of your most recent Social Security/Canada Pension statement, award letter and/or tax return and mail to:
Tel
10502 N Ambassador Dr., Suite #100 • Kansas City MO 64153-1291 816-891-6600 • Fax 816-891-9118 • E-mail [email protected] • Website www.iaap-foundation.org
