Cooper Tower Pre-Application

This form is used to determine your preliminary eligibility for the affordable apartments at Cooper Tower in Woodbridge. If eligible, you will be added to the waiting list and will be contacted as soon as a unit becomes available and we come to your name.

1. HEAD OF HOUSEHOLD INFORMATION

Salutation

First Name

Middle Name

Last Name

Suffix

Phone Number

Extension

Street Address

City

State

Zip Code

Please enter a five digit zip code.

2. HOUSEHOLD COMPOSITION

Please list all household members who will be living in the apartment. Cooper Tower is a rental development for seniors ages 62+ and people with disabilities.

1st Household Member (Head of Household)

Head of Household Name (First and Last Name)

Date of Birth

Gender

Is this household member permanently disabled?

YesNo

2nd Household Member

Will a 2nd person be living in your home?

YesNo

Name (First and Last Name)

Relationship to the Head of Household

Date of Birth

Gender

Is this household member permanently disabled?

YesNo

3rd Household Member

Will a 3rd person be living in your home?

YesNo

Please note that there are only studio and one bedroom units at Cooper Tower. Household of 3+ will not meet the eligibility requirements. To apply for additional locations, please submit a general Preliminary Application at our website: https://www.affordablehomesnewjersey.com/preliminary-application.

Name (First and Last Name)

Relationship to the Head of Household

Date of Birth

Gender

Is this household member permanently disabled?

YesNo

4th Household Member

Will a 4th person be living in your home?

YesNo

Name (First and Last Name)

Relationship to the Head of Household

Date of Birth

Gender

Is this household member permanently disabled?

YesNo

5th Household Member

Will a 5th person be living in your home?

YesNo

Name (First and Last Name)

Relationship to the Head of Household

Date of Birth

Gender

Is this household member permanently disabled?

YesNo

6th Household Member

Will a 6th person be living in your home?

YesNo

Name (First and Last Name)

Relationship to the Head of Household

Date of Birth

Gender

Is this household member permanently disabled?

YesNo

Additional Household Members

Will seven or more people be living in your home?

YesNo

3. REGIONAL INFORMATION

Does your household live or work in New Jersey?

YesNo

What Region or Regions do you and your intended household members LIVE or WORK in?

Region 1	Region 2	Region 3	Region 4	Region 5	Region 6
Bergen Hudson Passaic Sussex	Essex Morris Union Warren	Hunterdon Middlesex Somerset	Mercer Monmouth Ocean	Burlington Camden Gloucester	Atlantic Cape May Cumberland Salem

4. ADDITIONAL INFORMATION

What is the combined gross annual income for all Household Members?

Please enter without commas.

Please include the gross BEFORE tax income of all household members. Income includes gross wages, salaries, tips, commissions, overtime, alimony, child support, pensions, social security, unemployment, and disability benefits.

What are your current monthly rent payments?

Please enter without commas.

Do you have a Section 8 voucher?

YesNo

Will you receive rental assistance from other sources including family members outside of the household?

YesNo

What is the monthly amount of this assistance?

Please enter without commas.

What is your total household size?

Do any Household Members require a barrier free/ADA accessible home?

YesNo

Do you currently live in substandard/overcrowded housing?

YesNo

Are any household members Veterans?

YesNo

There are currently no units in our portfolio that provide a veterans preference. We are collecting this information in the event that a preference becomes available in the future.

Would you like to be contacted for studio apartments?

YesNo

All applicants will be considered for the one bedroom apartments. If you answer no, you will ONLY be contacted about one bedroom apartments.

5. SIGNATURE

How did you hear about CGP&H?

Once we come to your name on the waiting list, you will be asked to verify your household composition and income, among other factors. All information will be verified.
I certify that the information provided herein is true and complete and that any misrepresentation of income or household size reported herein shall be cause for program disqualification. I also understand that this information is to be used only for determining my preliminary eligibility for referral to an affordable housing unit and does not obligate me in any way.

E-Signature

Date

You will receive notification that your Preliminary Application was successfully submitted. If you do not receive this notification, please resubmit your Preliminary Application.

Contact Information