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Antioch Senior Interest List
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Email *
First Name *
Last Name *
Phone Number *
Desired Occupancy Date
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Current Address *
City *
State *
Zip Code *
Are you interested in the Family property or 55+ Senior property? *
What bedroom size are you looking for? *
Total Number of Household Members *
How many occupants are FULL time students? *
What is the household's monthly gross income? (Before taxes or deductions) *
Does your total household assets exceed $50,000k - (Checking, Savings, 401k, Money Markets, etc)  *
Does your household have a Housing Choice Voucher? *
Do you need to give 30 days notice where your currently live? *
When does your lease currently expire? *
When are you looking to move by? *
MM
/
DD
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Do you need a visual impaired unit? *
Do you need a hearing impaired unit? *
Do you need a mobility accessible unit? *
Within the next two years, do you plan to purchase a plug-in electric vehicle that requires
charging? *
Are you interested in our free after school program?  *
Message/Inquiry
A copy of your responses will be emailed to the address you provided.
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