Request for Transfer
Reason for Transfer Request:
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A) Verifiable Threat to Life, Health, or Safety of the Resident or Family Member
B) Medical Problems Resident initiated transfer requests may be made for an approved medical reason. Only resident request based upon medical circumstances of a life threatening nature shall be considered. All such requests shall be verified in writing by a physician and submitted to the development manager for consideration. 6 In order to be approved the medical condition shall be life threatening and there shall be a reasonable expectation that a transfer would improve or stabilize the medical condition.
C) Reasonable Accommodation Resident requests based upon “reasonable accommodation’ considerations shall also be considered. The Resident shall place all such requests in writing and filed with the HACF. The HACF shall require that the Resident verify all such requests by submitting appropriate documentation from third parties as may be required in the sole discretion of the HACF. In making decisions in regards to this type of transfer request, the Housing Authority shall comply with Section 504 of the Rehabilitation Act of 1973, as amended, and the Americans with Disabilities Act of 1990.
D) Occupancy Standards The HACF may initiate a transfer if the size of a family increases or decreases so that the apartment is no longer of the appropriate size based upon its established occupancy standards. The HACF shall not consider said transfer if the said transfer shall result in an undue financial burden for the HACF or if said transfer is solely necessary to minimize vacancies. All other transfer categories listed above shall receive priority over discretionary transfers. The HACF shall not be liable for any injuries or property damage sustained on any premises leased or assigned to the Resident except for injuries or property damage resulting from intentional or negligent action or omissions on the part of the HACF, the HACF representatives or agents.
Please explain reason for transfer:
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Leaseholder Full Name:
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E-mail:
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Phone Number:
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Site where you live:
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==Please select==
Westview
Willow
Gilmore
Douglas Village
Hosmer High-rise
Brewster High-rise
Parkside
Current Bedroom Size:
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==Please select==
0
1
2
3
4
5
Requested Bedroom Size:
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==Please select==
0
1
1 Handicap Accessible
2
2 Handicap Accessible
3
3 Handicap Accessible
4
4 Handicap Accessible
5
5 Handicap Accessible
Head of Household E-Signature:
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Last 4 of SS#:
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