Please indicate sources of income and medical reimbursement (if any):

Eden does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, VESSA, marital status, familial status, sexual orientation, military discharge, or military status, in any of its activities or operations. These activities include, but are not limited to, selection of Residents, hiring and firing of staff, volunteers and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all Residents and members of our community, staff, clients, volunteers, subcontractors, vendors, and clients.

Under state and federal laws, individuals with disabilities may request reasonable accommodations from housing providers and we must consider the request. Reasonable accommodations in rules, policies, practices, and services must be allowed to give persons with disabilities an equal opportunity to use and enjoy housing, provided such accommodation does not impose an undue hardship or requests a change in the fundamental nature of our business. Residents with disabilities must be allowed to make reasonable modifications to their apartments and common areas subject to appropriate construction and restoration considerations. Any resident or applicant seeking a reasonable accommodation should complete a Confirmation Of Request For Reasonable Accommodation form and return it to the Executive Director. This application is not a rental agreement, contract or lease. All applications are subject to the approval of the owner or managing agent. I (we) certify under penalty of perjury that the information and statements provided above are true and complete to the best of my (our) knowledge. I (we) consent to release this information. I (we) understand that providing false information may be grounds for denial of my (our) application and may subject me (us) to criminal penalties. I (we) give consent and authorization to have management verify the information contained in this application for the purpose of approving my (our) eligibility for occupancy. I (we) will provide all necessary information to expedite this process. I (we) understand that my (our) occupancy is contingent on meeting resident selection criteria and the Low Income Housing Tax Credit Program guidelines (Eden Champaign only). I (we) understand and agree that inquiries may include in formation related to credit, employment, rental and criminal records. I (we) further agree that verification of all information and references regarding sources of income and assets may be conducted and I (we) release all parties for any liability for disclosing factual information obtained by management. I (we) understand and agree that a photocopy or fax of this authorization can be used in lieu of an original. The $125.00 application fee is not refundable if Lessor declines the applicant. Moreover, if the Applicant choose not to rent the premises, then all application fees and any and all security deposits or monies used to hold the apartment shall be retained by leaser as liquidated damages.