WELCOME HOME Jamie Taylor, Regional Housing Director Tiffany Treagus, Asst. Regional Housing Dtr. Hampton Roads Welcome Center 7924 4th Street Norfolk, VA 23505 (757) 961-3783 phone (757) 961-4430 fax jamtaylor@lpsi.com www lincolnmilitary.com ‘ery Mision Begins Home™ Dear Future Resident: Welcome to Lincoln Military Housing, a partner of the Navy. We are very happy that you have chosen Hampton Roads’ Public Private Ven- ture for your housing needs. Since 1965, Lincoln Military Housing has maintained a reputation as the premier manager of apartment communities across the United States. We are proud of our time-honored commitment to excellence and we will continually strive to make your home a special place to live, ‘To become a resident of Lincoln, you will need to complete a qualifi- cation process with our government partners. Please fill out the at- tached paperwork and retum to us by fax, mail or e-mail at the infor- mation listed below. The following papers must be submitted with your application © Acopy of your orders + Acopy of your Page 2 Upon receipt of your application you will be contacted by our leasing specialists who will assist you in finding a home that suits your fam- ily’s needs. At Lincoln Military Housing we understand that quality of life is para- mount. That is why our primary objective is to create a sense of well- being and comfort for the military families that live there, We truly believe “Every Mission Begins at Home”™, Welcome to Hampton Roads!Navy Housing NAVAL SUPPORT ACTIVITY ee, FAMILY HOUSING PROGRAM FOR SAILORS N93 AND FAMILIES FAX Date: Number of pages including cover sheet: From: Phone: Fax: Email: To: Phone: 757-445-2832 or DSN 565-2832 i Fax: 757-445-6818 or DSN 563-6818 7924 14" Street Norfolk, VA 23505-1217 Subj: Housing Application Package Please check below documents attached. LJ Housing Application Cover Sheet L Application for Assignment to Housing (DD Form 1746) Sex Offender Policy Acknowledgement & Disclosure Form Housing Applicant Statement of Understanding, Courtesy Move (Household Goods) Entitlement Permanent Change of Station (PCS) Orders USN ~ Page 2; USMC - NAVMC 10922; USA & USAF ~ DD Form 93; USCG ~ 4170 Dual Military — Provide documentation (orders & page 2) on spouse Custody/Divorce Papers (If previously married or legally separated) Proof of Pregnancy with estimated due date noted by doctor Power of Attorney (required if spouse or representative is completing application) a ao O Oo C2 Record of Emergency Data/Dependency Application Oo Oo Oo es)PPV HOUSING APPLICATION COVER SHEET Social Security Number Branch of Service Name Rate/Rank ast, First, MD) Ultimate Duty Station UIC _ PRD EAOS _ Duty Phone Home Phone Member's Cell Spouse cell __ Home Address City, State Zip Home Email Address Work Email Address CHECK YES OR NO TO THE FOLLOWING QUESTIONS: e? Yes No Are you presently in Military Housing / PPV Hous If yes, date assigned and address Have you vacated Military Housing / PPV Housing? Yes [) No (J Ifyes, date vacated and address Is spouse a Military Member? Yes] No (1 If yes, Member’s Name Rate/Rank, Duty Station uIc Provide copy of member's orders and page two (Record of Emergency Data). Are you enrolled in the Exceptional Family Member Program? Yes [) No Ifyes, what category ___ Verified with Date of Enrollment Do you have any special requirements? igle level, ramp, etc.) Are you currently ina lease? Yes ] No (1) Ifyes, date it expires _ ‘Are you leasing with a Rental Partnership Program Complex? Yes] No 1 Do youhaveapet? YesC] No [] How Many ___ What Type = ***No Chows, Doberman Pinschers, Presa Canarios, Pit Bulls, Rottweiler’s, Wolf Hybrids or any mixes thereof will be permitted. No barnyard or exotic pets such as chickens, ducks, ferrets, rabbits, rey |. OFFICE USE ONLY Effective Control Date Priority _ Bedroom Area Preference Member Entitled to Courtesy Move: Yes] No O Date entered into the computer _____ Staff Name = (Revised Feb 2012)“APPLICATION FOR ASSIGNMENT TO HOUSING T._TVPE SERVICE DESIRED Nomar) [ewutanvysouene | ——[s nousne enna ‘SECTION I~ APPLICANT INFORMATION AME OF SPONSOR ne, Fit Mase mua | 8 PAY GRADE, 7H 5. DOD COMPONENT ]6. ADDRESS ‘Sineer, Cry, Stace, Zip Coe) 7._TELEPHONE NUMBE R ‘STATUS OF APPLICANT 2 one) > DUS TARY mova = evi ‘9. WARITAL STATUS 70. 1AM SEPARATED FROM MY DEPENDENTS on) Ti TREQUEST HOUSING FOR nom ‘SECTION I1- MILITARY CAREER INFORMATION ron ip fom 15) To. sei omy [x sar me omroioans 4, DATES iri Palo ace) WRiTARY APPLICANT] MATAR SPOUSE "TZ. INSTALLATION/ORGANIZATION TRANSFERRED FROM "3. INSTALLATION/ORGANIZATION TRANSFERRED TO ‘SECTION IN - DEPENDENT DATA "15. DEPENDENTS RESIDING WITH ME imu paces nsdn, conan on a papar] 1 REAARRS tap beth polos, epic nso 4 RELATIONSHe Poolgor ‘SECTION IV - HOUSING DATA "16, COMMUNITY HOUSING DESIRED osm) "17. AMENITIES DESIRED ov annenun We rater ind ond) 8. DATE HOUSING NEEDED 8 PRICE RANGE = AR CONDONE OTHER x 7B. LOGATION PREFERENCE ‘Conran Hosa i REWARKS "22. SIGHATURE OF APPLICANT” - 23. DATE SUBIATTTED "SECTION V - DISPOSITION iat coin by i ng eo 24,_ MILITARY HOUSING ‘SECTION VI- HOUSING REFERRAL CERTIFICATE ‘On this date | have received a listing of the housing restrictions approved by the installation Commander, and ! will not reside in any property on the: restricted list. I have been briefed on (1) the services provided by the Housing Office, 12) the DoD program on equal opportunity for military personnel in off-base housing, and (3) nondiscrimination based on physical ‘or mental handicaps, In addition, if any facility refuses to rent or sell to me or | have reason to believe | am being discriminated against, | will promptly notty Office 26. DATE SIGNED DD Form 1746, SEP 93 Previous editions may be usedSEX OFFENDER POLICY ACKNOWLEDGEMENT & DISCLOSURE PRIVACY ACT STATEMENT [Authority: 10 U.S.C. § 5013, 10 U.S.C. § 5047, 10 USC. § 2831, DoD 4165.63-M and E.0. 0307. IPrincipte Purposes: To determine an individual's eligibility for Navy housing; including privatized housing, [Routine Uses: Used by region and installation housing office personnel to determine eligibility for Navy housing and by private partners who operate privatized Navy housing for management and operational purposes. Disclosure: Voluntary; however, failure to provide the requested information may impact eligibility for Navy housing, including privatized housing POLICY STATEMENT: In accordance with OPNAVINST 1752.3, to the maximum extent permitted by law or jotherwise waived by Commander, Navy Installations Command or the Chief of Naval Personnel (CNP), sex loffenders are to be identified & prohibited from accessing Navy facilities and occupying Navy owned, leased, or [PPV housing. |Sex Offender Definition: Any person convicted of a criminal offense requiring registration per the National Guidelines for [Sex Offender Registration and Notification Act (SORNA) (42 U.S.C. §§ 16901-16962) NOTICE OF REQUIREMENT TO DISCLOSE val }. Miltary sponsors requesting assignment to Navy owned, leased or privatized housing are required to | INIT [sign this acknowledgment and disclosure form. \2. Occupancy of Navy owned, leased or privatized housing will not be approved for otherwise eligible lapplicants if the applicant, any authorized dependent, or live-in aide residing in the home is a sex offender. {3. Anyone discovered to be a sex offender in the application process shall be denied access to Navy lowned, leased or privatized housing |4. Anyone found to be a sex offender after taking occupancy may lose the privilege of residing in Navy lowned, leased or privatized housing, may be barred from the installation, andlor may be evicted. If eviction loccurs you may be responsible for ail relocation expenses. 5. The Installation or Region Housing Program Director will immediately forward information regarding identified sex offenders to the Installation N3, N9 and supports SJA/OGC offices, to include a copy of the [applicant's DD 1746 and this form. All information will be forwarded fo CNIC within two working days. \6. Anyone found to have falsely certified this Acknowledgment shall be referred for barment or eviction, as lappropriate, and may be responsible for relocation expenses. |7. Denial of an application for assignment to Navy owned, leased or privatized housing under the [applicable policy, may be appealed to the Region Commander via the military sponsor's chain of |commang, CERTIFICATION: | have read and understand the above policy. By my signature below, | certify that under a penalty of !administrative action andlor prosecution for making a false official statement in violation of 18 U.S.C § 1001 and/or the \Uniform Code of Miltary Justice, Article 107, that neither | nor any person living in my household is a registered/convicted| |sex offender. | understand that | am required to notify the Navy's Housing Office and the Installation Security Office immediately if circumstances change so that this certification is no longer true. Signature Date Print Name Command] “ONIG 1110301 02/1 ‘Adobe 8.0PRIVATE PUBLIC VENTURE (PPV) STATEMENT OF UNDERSTANDING 1 T understand waiting times for Public Private Venture Housing (PPV) are only esti subject to change. ates and 2. 1am required to keep the Navy Housing Service Center advised of any changes to my application (i.e. lease or Rental Partnership Program (RPP) expiration, rate, family members, address, phone numbers, e-mail addresses, etc.). I am required to provide housing with advance notice that I am unable to accept PPV housing until a specifie date. 3 L understand that a maximum of two (2) pets (dogs and/or cats) are permitted. Pet quantities exclude birds and fish. No Chows, Doberman Pinschers, Presa Canarios, Pit Bulls, Rottweilers, Wolf Hybrids or any mixes thereof will be permitted. No bamyard or exotic pets such as chickens, ducks, ferrets, rabbits, reptiles ete. will be allowed. I understand any damages caused to the unit or grounds by my pet(s) are also my responsibility. 4. J understand that I must have six months or more remaining on my tour of duty to be assigned PPV housing. 5 J understand that I will not be eligible to reapply for larger quarters if I accept smaller quarters than those to which I am entitled unless my current family composition changes. 6 J understand that assignment to PPV housing will be accepted in writing. Acceptance may be made by sponsor or sponsor’s designee with a Special Power of Attorney (must state “start, stop and change allotment).” a Lunderstand that when offered PPV housing; I have 24 hours to accept or to decline. Tunderstand that if I decline my one PPV housing offer, I will be PERMANENTLY removed from the waiting list. 9. Tam aware that the Privacy Act of 1974 prohibits release of personal information without my approval. I do hereby authorize the Navy Housing Service Center to release the information contained in this family housing application to the Public Private Venture Managing Member for purposes of placement on the family housing waiting list and placement in a public private venture home. 10.__ Navy Housing Service Center counselors are your advocates in dealing with landlord/tenant issues whether you are living in Public Private Venture (PPV) or Community housing, (Print Name & Sign) ~ = (ate) NAVSUFPACT BH-2 0006 (Revised 2/2012)COURTESTY MOVE (HOUSEHOLD GOODS) ENTITLEMENT Based on Commander, Navy Installations Command (CINC) policy to qualify for a courtesy move you must meet the following: Eligibility ‘© Member is eligible for courtesy move when member receives PCS orders and applies for PPV housing within 30 days of reporting to his/her command in the Hampton Roads area and PPV housing is not available © Member not eligible (bachelor) for PPV housing when PCS to Hampton Roads area but becomes cligible due to change from member with no dependents to member with dependents member must apply for PPV housing within 30 days of change of status to be eligible for courtesy move. Forfeits Eligibility © Member fails to apply for PPV housing within 30 days of report date to command on PCS orders to Hampton Roads area, * Member fails to apply for PPV housing within 30 days of becoming eligible (ic. marriage/pregnancy.) * Member is referred to turns down the home. coln Military Housing for housing and is offered a PPV home and This is to certify that I have been briefed and understand the above. I understand I am responsible for moving expense if I am not entitled to a courtesy move and when eligibility has been forfeited (Print Name and Sign) ‘atey OFFICE USE ONLY (Report Date) (Date of Application) New Apri 2010