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ASSISTED LIVING FACILITY FOR $2,372.50 a MONTH INSTEAD OF $7000 --LOTTERY TO BE HELD
Release Date: March 02, 2015

APPLICATION POSTED BELOW FOR AFFORDABLE ASSISTED LIVING FACILITY
4 units will be offered at discounted rates to winners of lottery---application due April 15th
 
Living in an assisted living facility is very expensive. It's unaffordable for the middle class and those who are on limited incomes.  Monthly rents are as  could be as high as $7000 a month. Many Greenburgh residents (elderly and children of elderly) have asked me to work on this cause.  I believe that local governments and the town of Greenburgh should do more to make assisted living opportunities affordable. I intend to propose that a certain number of rooms in assisted living facilities in Greenburgh  be affordable to lower income residents before approvals are granted.  When new applications are presented to the Town Board I hope we can follow the  lead of the village of Scarsdale.  I'm also hoping that in the future a 100% affordable assisted living facility can be built in our town. 
 
The Ambassador is a new assisted living facility in Scarsdale on Saxon Woods Road. The village required the Ambassador to make 4  units affordable---$2,372.50 per individual per month. A lottery is being held on April 20th. The complex will have a total of 115 units. Shared two bedroom suite with private bath. The basic package includes rental, utilities, 3 meals a day plus bistro snacks and beverages, weekly housekeeping, transportation to doctors’ offices, scheduling shopping and activities, medication ordering and monitoring for residents who can self administer, daily activities and supervised wellness programs.  
 
 
Eligibility Requirements: In order to qualify for the units, household income must be at or below 60 percent of the area median income for Westchester County based on HUD Income Guidelines. Assisted Living Unit Details:
Unit Type Quantity Basic Monthly Rate* Max Income (1 person)
Shared Two-bedroom 2 $2,372.50 per month $43,560
 
 
 
Housing Action Council
01/15
APPLICATION FOR ASSISTED LIVING AT
THE AMBASSADOR OF SCARSDALE
9 Saxon Woods Road, Scarsdale, NY 10605
APPLICATION DEADLINE: APRIL 15, 2015
(Applications must be received by Housing Action Council on or before April 15, 2015)
LOTTERY: April 20, 2015
Only one (1) application per household. If your name is on more than one application you will be disqualified.
Mail or Hand Deliver Application to:
Housing Action Council at 55 South Broadway, Tarrytown, NY 10591
Phone: 914-332-4144
1. APPLICANT INFORMATION:
Name: ______________________________________________________________________________
Address:______________________________________________________________ Apt#: __________
City: _________________________________ State: __________________ Zip: ____________________
Home Phone: ________________ Cell Phone: _________________ Work Phone: ____________________
SSN: ______________________DOB: _____________________Gross Income: ____________________
Email: ______________________________________________________________________________
……………………………………………………………………………………………………………………………..................
2. STATISTICAL INFORMATION
a. The following information is required for statistical purposes so that the Department of Housing and
Urban Development (HUD) may determine the degree to which its programs are utilized by people
of different racial & ethnic backgrounds.
Housing Action Council
01/15
RACIAL GROUP IDENTIFICATION: Used for statistical purposes only. (Please check only one from this
group for the head of household only).
_____ White _____ American Indian or Alaska Native & White
_____ Black or African American _____ Asian & White
_____ Asian _____ Black or African American & White
_____ American Indian or Alaska Native _____ American Indian or Alaska Native & Black or
_____ Native Hawaiian or Other Pacific Islander African American
_____ Other Multi Racial
b. ETHNICITY: (check only one from this group) ______ Hispanic ______ Non-Hispanic
……………………………………………………………………………………………………………………………..................
3. RENT:
What is your Current Monthly Rent $_____________
Check Utilities paid by you now:
? Heat $_____________ per month
? Electricity $_____________ per month
? Gas $_____________ per month
? Water $_____________ per month
? Other $_____________ per month
……………………………………………………………………………………………………………………………………………
4. SOURCES OF INCOME:
List ALL sources of income (EXAMPLES: social security, SSI, pensions, disability compensation, earned income,
annuities, dividends, and income from rental property)
SOURCE AMOUNT
_________________________ _______________________________ __________ $___________
Weekly/ biweekly/ monthly (circle one)
_________________________ _______________________________ __________ $___________
Weekly/ biweekly/ monthly (circle one)
_________________________ _______________________________ __________ $___________
Weekly/ biweekly/ monthly (circle one)
Housing Action Council
01/15
5. HOUSEHOLD ASSETS:
Checking Accounts:
Bank: _______________________________ Acct. No.:_______________________ Amt.: ____________
Bank: _______________________________ Acct. No.:_______________________ Amt.: ____________
Savings Accounts: (includes Passbook/Statement and Christmas/Vacation Clubs)
Bank: _______________________________ Acct. No.:_______________________ Amt.: ____________
Bank: _______________________________ Acct. No.:_______________________ Amt.: ____________
Certificates of Deposit (CD's):
Bank: _______________________________ Acct. No.:_______________________ Amt.: ____________
Bank: _______________________________ Acct. No.:_______________________ Amt.: ____________
Bank: _______________________________ Acct. No.:_______________________ Amt.: ____________
Credit Union Shares:
Credit Union Name: _________________________________ Amt.: ______________________________
Address _____________________________________________________________________________
Stocks/Bonds (value): $ ________________________ Savings Bonds (value): _______________________
Other Amt.: (includes IRA's, trust, mutual funds, etc.) $ ________________________________________
Does the applicant or co-applicant NOW own real estate: _____YES _____NO
If "yes", what is the value: _______________________________________________________________
Has the applicant or co-applicant EVER owned real estate? _____YES _____NO
If "yes", when? _______________________________________________________________________
Do you own a house? ____ Yes ______ No
I DECLARE THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE. WARNING: WILLFUL FALSE
STATEMENTS OR MISREPRESENTATIONS ARE A CRIMINAL OFFENSE.
_______________________________________ ________________________
Applicant Signature Date
Housing Action Council
01/15
CONSUMER CREDIT INFORMATION
I/ We hereby authorize Housing Action Council and the Ambassador at Scarsdale and its agents to use any consumer
reporting agency, credit bureau or other investigative agencies employed by such, to investigate references, or
statements or other data obtained from me or from any person pertaining to my employment history, credit, prior
tenancies, character, general reputation, personal characteristics and mode of living, to obtain a consumer report and
such other credit information which may result thereby, and to disclose and furnish such information to the organizations
listed above, to the owner, and to agencies that made or will make funding available in connection with this property
listed above in support of this application. I have been advised that I have the right, under 606B of the Fair Credit
Reporting Act, to make a written request, within reasonable time, for a complete and accurate disclosure of the nature
and scope of any investigation.
______________________ _________________
Applicant Signature Date
6. HOW DID YOU HEAR ABOUT THIS DEVELOPMENT?
? Friend
? Employer
? Sign Posted on Building
? Website/ Internet __________________________________________________________ (list site)
? Newspaper (Identity):______________________________________ On-line Version? ____________
? Church/ Synagogue (Identify):_____________________________________________________________
? Community Organization (Identify):_________________________________________________________
? Other (Identify): ______________________________________________________________________
7. DOCUMENTATION
All household members must submit COPIES of the following documents with their application:
________ 2014 & 2013 W2’s and Federal Tax Returns with all Schedules
_________ One Month’s Most Recent Pay Stubs & documentation on any other source of income,
e.g. social security, pension, disability, annuity payments
_________ 3 Months of all Bank, Credit Union, and Investment Statements (all pages)
_________ Most Recent Retirement Fund Account Statements (e.g. 403b, 401k)
_________ Birth Certificate, Drivers License or Passport
Housing Action Council
01/15
I DECLARE THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE. WARNING: WILLFUL FALSE
STATEMENTS OR MISREPRESENTATIONS ARE A CRIMINAL OFFENSE.
_______________________________________ ________________________
Applicant Signature Date
_______________________________________ ________________________
Co-Applicant Signature Date
Mail or Hand Deliver Application to:
Housing Action Council at 55 South Broadway, Tarrytown, NY
 
for more information contact the housing action council
 
http://www.housingactioncouncil.org/
Paul Feiner
****************************************************
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