Applicant Name
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First Name
Last Name
Applicant Email
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Applicant Phone
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(###)
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Responsible Party Name
First Name
Last Name
Responsible Party Phone
(###)
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Responsible Party Email
How did you hear of this opportunity?
Online
Current Cohome Resident or Participant
Support Coordinator or Case Manager
School or Transition Program
Social Media (Instagram, Facebook, etc.)
Online Search (Google, Bing, etc.)
News Article or Blog
Community Event or Conference
Flyer or Brochure
Professional Referral (Healthcare Provider, Therapist, etc.)
Another Organization or Nonprofit
I’ve known about Cohome for a while
Select your program(s) of interest
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Are you enrolled in NJ DDD services?
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If you are not enrolled in NJ DDD, please download and upload the Disability Certification Form in the instructions.
Date of Birth
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MM
DD
YYYY
Select your income category
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Less than $20,000
$20,000 – $34,999
$35,000 – $59,999
$60,000 – $84,999
$85,000 – $104,999
$105,000 – $124,999
$125,000 – $149,999
$150,000 or more
Tell Us More About You
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This section helps us get to know you beyond the basics. Please provide any relevant information that will support your application.
How do you spend you day?
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Please select all that apply.
If selected, when would you be available to move in?
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Please select the earliest date you would be ready to move in. This helps us plan for openings and match you with the right opportunity.
MM
DD
YYYY
Attestation
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By submitting this application the Applicant attests to and agrees with the following terms and conditions:
1. ELIGIBILITY AND ACCURATE INFORMATION
Applicant acknowledges that eligibility for this Supportive Housing opportunity requires meeting specific criteria, including income limits and a documented intellectual and/or developmental disability. Applicant certifies that they meet these criteria and understands that providing false or misleading information may result in disqualification and termination of any resulting tenancy. Applicant certifies they have provided accurate and verifiable documentation.
2. COMPLIANCE WITH ELIGIBILITY REQUIREMENTS
Applicant acknowledges that this housing is designated as Supportive Housing for individuals with intellectual and/or developmental disabilities who meet specific income eligibility requirements. The Applicant agrees to maintain compliance with these criteria throughout their tenancy. Any changes in the Applicant's circumstances that may affect continued eligibility (e.g., changes in income or disability status)must be promptly reported in writing to the Company. Failure to provide timely notice or comply with eligibility requirements may result in disqualification or other applicable remedies.
3. PRIMARY RESIDENCE
Applicant agrees that, if accepted, the unit must be their primary residence, legally defined as the main home where one resides for most of the year. An individual may only have one primary residence at any time.
4. COMMUNICATION & MEDIA RELEASE
4.1 Release Authorization: Applicant grants the Company permission to use their name, likeness, photographs, and other relevant personal information for promoting the Supportive Housing opportunity through Company communications, including social media channels, the Company’s website, and other promotional materials. Additionally, Applicant authorizes the Company to share necessary information with third-party providers, partners, and agencies for validating eligibility or for purposes associated with tenancy.
4.2 Consent: Applicant understands that this release is voluntary and may be withdrawn at any time by providing written notice to the Company. However, the Company retains the right to share necessary information with third parties to ensure compliance and eligibility as required by law or program requirements.
4.3 No Compensation: Applicant acknowledges they will not receive compensation for the use of their name, likeness, photographs, or personal information in connection with promotional materials or for the sharing of information with third parties as described herein.
5. SEVERABILITY
5.1 Enforceability of Provisions: If any provision of this Attestation is deemed invalid, illegal, or unenforceable by a court, such provision shall be considered severable, and the remaining provisions shall remain in effect to the fullest extent permitted by law.
5.2 Modification of Invalid Provision: Should any provision be determined invalid, the parties will make a good faith effort to replace it with a valid provision that most closely achieves the intended effect of the invalid provision.
6. INFORMATION CONSENT AND RELEASE
6.1 Information Sharing with Company: Applicant agrees to provide the Company with pertinent information upon request, including but not limited to contact details, emergency contact information, and any information necessary to verify eligibility.
6.2 Information Sharing with Third Parties: Applicant consents to the Company’s sharing of their information with contractors, vendors, and other service providers as needed to facilitate the services and support provided. This may include but is not limited to maintenance personnel, affordable housing professionals, government officials, and other third parties involved in program administration and operations.
7. BINDING ARBITRATION OF DISPUTES AND ATTORNEYS’ FEES
If any dispute arises from or relates to this Supportive Housing Opportunity such as eligibility and selection, the sole means of resolution will be binding arbitration under the auspices of a mutually agreed-upon arbiter. Arbitration awards may be enforced as judgments in courts of competent jurisdiction. Each party will be responsible for its own costs, including attorneys’ fees, in the arbitration. This arbitration clause will apply to all disputes, including those arising after termination of this Attestation or cessation of tenancy.
Attorneys’ Fees and Collection Costs: If any legal action, arbitration, or other proceeding is brought for the enforcement of this Supportive Housing Application Attestation, the prevailing party shall be entitled to recover reasonable attorneys’ fees and all other costs incurred.
8. AGREEMENT TO TERMS
By submitting this application, the Applicant attests to and agrees to abide by the terms and conditions set forth in this Supportive Housing Application Attestation. The Applicant affirms that all information provided to the Company is correct and commits to adhere to these stipulations, fostering a supportive and harmonious living environment. The Applicant further acknowledges that acceptance is contingent upon agreement with these terms.
9. GOVERNING LAW
This Attestation shall be governed by and construed in accordance with the laws of the State of New Jersey. Any disputes arising under or in connection with this Attestation shall be resolved in the state or federal courts located in New Jersey.
