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It requests completion of an attached rental application and release of information, including identification, citizenship and income documentation for all household members, residence history for the past three years, household member details, and sources of income and assets. It also collects criminal history and lifetime sex offender registration status, plus Equal Housing Opportunity/Fair Housing Law monitoring data, and explains background/credit checks and consent to verify provided information.",{"@graph":63,"@context":123},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/pine-street-rental-application-and-release-of-information-rental-application-form/306175/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/pine-street-rental-application-and-release-of-information-rental-application-form/306175.png","ImageObject",442,249,{"name":88,"@type":89},"Skyler","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-07","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115,119],{"name":106,"@type":107,"acceptedAnswer":108},"What documents must be included with the completed application?","Question",{"text":109,"@type":110},"A copy of birth certificate, social security card, photo ID for household members over 18, proof of citizenship status if applicable, proof of current income for all household members, and bank statements for all accounts of each household member must be submitted.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"When is the application deadline and where should it be submitted?",{"text":114,"@type":110},"Applications must be received by Tuesday March 13t, 2018. Submit by mail or hand-deliver to Blackstone Valley Community Action Program, 32 Goff Avenue, Room 204, Pawtucket, RI 02860.",{"name":116,"@type":107,"acceptedAnswer":117},"What checks are performed after the application is received?",{"text":118,"@type":110},"After receipt, background and credit checks are performed for all household members of legal age, and household income is verified. Incomplete applications cannot be processed.",{"name":120,"@type":107,"acceptedAnswer":121},"Is providing this information optional and does it guarantee occupancy?",{"text":122,"@type":110},"The application collects information required to monitor compliance with Equal Housing Opportunity and Fair Housing laws; providing the information does not guarantee occupancy. Management verification is authorized by the applicant’s signature, and false statements can affect approval.","https://schema.org",{"og:url":78,"og:type":125,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":127,"canonical":78},"index,follow",{"doc_id":129,"site_id":56},306175,1790447733,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":88,"user_avatar":134,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":47,"language":140,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":61,"update_tm":144,"read_time":73},2336464648746,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Blackstone ValleyCommunity Action Program32 Goff Avenue  \nPawtucket,Rhode Island 02860401.723.4520Fax 401.725.6550www.bvcap.org  \nJames R.Hoyt,Jr.  \nChairman  \nVincent CeglieExecutive Director  \nThank you for your interest in leasing out apartment located at 173 Pine Street 2ndFloor,Pawtucket,RI02860.Attached is the rental application form and release of information that you willneed tocomplete.  \nWhen submitting your completed application,please include a copy of the following information (thisapplies to all members of vour household as listed on vour application):  \n1.Birth Certificate  \n2.Social Security Card  \n3.Photo ID (All household members over the age of 18)  \n4.Proof of Citizenship Status(if applicable)  \n5.Proof of all current sources of income for all household members(Including,but not limited to:Employment,Unemployment,Social Security,SSI,DHS,Pensions,FIP,TDI,Worker'sCompensation,Etc.)  \n6.Bank Statement(All accounts of each household member)  \nPlease mail or hand-deliver your application to:  \nBlackstone Valley Community Action Program32 Goff Avenue,Room 204Pawtucket,RI 02860  \nAll applications must be received by Tuesday March 13t,2018.  \nOnce we receive your application we will perform a background and credit check for all householdmembers of legal age.We will also verify your household income.  \nAny application not fully completed,cannot be processed.Should you have any questions,please contact us at 401-723-4520x299.  \nLocation:173 Pine Street,2nd Floor,Pawtucket,RI 02860  \nApplicant Name:                          \nE-Mail:                                                                        \nPLEASE LIST ALL PERSONS THAT WOULD OCCUPY THE APARTMENT:NAMESOCIAL SECURITY NUMBER  \n\n| 1   | Head of Household   |\n| --- | --- |\n| 2   |  |\n| 3   |  |\n| 4   |  |\n| 5   |  |\n| 6   |  |\n| 7   |  |\n| 8   |  |\n\nPLEASE PROVIDE YOU RESIDENCE HISTORY FOR THE PAST 3 YEARS  \n\n| CURRENT STREETADDRESS(STREET,CITY,STATE,ZIP CODE):   |\n| --- |\n| LANDLORD ADDRESS:  \u003Cbr>LANDLORD NAME:  \u003Cbr>LANDLORD PHONE NUMBER:   |\n| LENGTH OF RESIDENCE:  \u003Cbr>OWN HOME:□YES □NO  \u003Cbr>RENT PAID PER MONTH:  \u003Cbr>LEASE EXPIRATION:  \u003Cbr>IF YES,APPROX VALUE:  \u003Cbr>BALANCE OWED:   |\n\n\n| PREVIOUS STREET ADDRESS(STREET,CITY,STATE,ZIP CODE):   |\n| --- |\n| LANDLORD NAME:  \u003Cbr>LANDLORD PHONE NUMBER:  \u003Cbr>LANDLORD ADDRESS:   |\n| OWN HOME:□YES□ NO  \u003Cbr>LENGTH OF RESIDENCE:  \u003Cbr>RENT PAID PER MONTH:  \u003Cbr>IF YES,APPROX VALUE:  \u003Cbr>LEASE EXPIRATION:  \u003Cbr>BALANCE OWED:   |\n\n\n| PREVIOUS STREET ADDRESS (STREET,CITY,STATE,ZIP CODE):   |\n| --- |\n| LANDLORD PHONE NUMBER:  \u003Cbr>LANDLORD ADDRESS:  \u003Cbr>LANDLORD NAME:   |\n| LENGTH OF RESIDENCE:  \u003Cbr>RENT PAID PER MONTH:  \u003Cbr>OWN HOME:□YES□NO  \u003Cbr>IFYES,APPROXVALUE:  \u003Cbr>LEASE EXPIRATION:  \u003Cbr>BALANCE OWED:   |\n\nList all the states you and any member of your household have resided in previously:_                 \nEach Applicant of legal age mustcomplete a separate application.  \nHome Phone:                          \nCell Phone:                 \nRELATIONSHIP  \nHave you ever been convicted,pleaded guilty or received a sentence in connection with a crime?□Yes □ NoIf yes,please explain:                                           \nAre you or any member of your household subject to a Lifetime Sex Offender Registration in any state?  \n□Yes □ No  \nPROVIDE ALL SOURCES OF INCOME THAT YOUR HOUSEHOLD RECEIVES(Use additional sheets if necessary):  \n\n| HOUSEHOLD MEMBER:  \u003Cbr>EMPLOYER ADDRESS:  \u003Cbr>EMPLOYER:   |\n| --- |\n| MONTHLY INCOME:  \u003Cbr>LENGTH OF EMPLOYMENT:  \u003Cbr>EMP FAX:  \u003Cbr>EMP TELE:  \u003Cbr>SUPERVISOR NAME:   |\n| EMPLOYER ADDRESS:  \u003Cbr>EMPLOYER:  \u003Cbr>HOUSEHOLD MEMBER:   |\n| EMP FAX:  \u003Cbr>EMP TELE:  \u003Cbr>LENGTH OF EMPLOYMENT:  \u003Cbr>MONTHLY INCOME:  \u003Cbr>SUPERVISOR NAME:   |\n\n# OTHER SOURCES OF INCOME\n\n\n| MONTHLY INCOME FROM SOURCE:  \u003Cbr>SOURCE:  \u003Cbr>HOUSEHOLD MEMBER:   |\n| --- |\n| MONTHLY INCOME FROM SOURCE:  \u003Cbr>HOUSEHOLD MEMBER:  \u003Cbr>SOURCE:   |\n| MONTHLY INCOME FROM SOURCE:  \u003Cbr>HOUSEHOLD MEMBER:  \u003Cbr>SOURCE:   |\n| MONTHLY INCOME FROM SOUR","cbCaia0VCB48R2iC","https://ap.wps.com/l/cbCaia0VCB48R2iC","pdf",770961,"English","# Applicant Information\n## Household Members and Occupancy\n## Residence History (Past 3 Years)\n# Eligibility and Background Questions\n## Criminal Convictions\n## Lifetime Sex Offender Registration\n# Income and Asset Disclosure\n## Sources of Income\n## Assets and Bank Accounts\n# Additional Household Details\n## Higher Education Enrollment\n## Pets\n# Equal Housing Opportunity & Fair Housing Data\n## Protected-Status Monitoring (Race/National Origin)\n# Consent and Signature\n## Management Use and Completion Date/Time","[{\"question\":\"What documents must be included with the completed application?\",\"answer\":\"A copy of birth certificate, social security card, photo ID for household members over 18, proof of citizenship status if applicable, proof of current income for all household members, and bank statements for all accounts of each household member must be submitted.\"},{\"question\":\"When is the application deadline and where should it be submitted?\",\"answer\":\"Applications must be received by Tuesday March 13t, 2018. Submit by mail or hand-deliver to Blackstone Valley Community Action Program, 32 Goff Avenue, Room 204, Pawtucket, RI 02860.\"},{\"question\":\"What checks are performed after the application is received?\",\"answer\":\"After receipt, background and credit checks are performed for all household members of legal age, and household income is verified. Incomplete applications cannot be processed.\"},{\"question\":\"Is providing this information optional and does it guarantee occupancy?\",\"answer\":\"The application collects information required to monitor compliance with Equal Housing Opportunity and Fair Housing laws; providing the information does not guarantee occupancy. Management verification is authorized by the applicant’s signature, and false statements can affect approval.\"}]","Pine Street Rental Application and Release of Information - Rental Application Form | PDF",1789833425]