Preliminary Application - Lascana Homes of Orange, CT
Income Qualification & Waitlist Registration
⚠️ Income Eligibility Notice
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Total Number of Adults, 18 and over:
*
Number of Children under 18:
*
When are you looking to move?
-
Month
-
Day
Year
Date
Total estimated yearly income for everyone in your household before taxes, when combined:
*
Bedroom Size Requested:
*
1-Bedroom Unit
2-Bedroom Unit
3-Bedroom Unit
Wheelchair Accessible Unit
Are you Elderly?
*
Yes
No
Do you own pets?
*
Yes - Not Certified
Yes - Certified SA/ESA
No
Will this be your only place of residence?
*
Yes
No
Will you take an apartment when one is available?
*
Yes
No
Do you currently receive any rental assistance - (RAP or Section 8, etc.)?
*
Yes
No
If yes, please explain:
*
Student Status:
*
Full-Time
Part-Time
Not a Student
Please provide any additional information about your application and interest in applying for housing:
Please verify that you are human
*
Submit
Should be Empty:
