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The Towers Application for Golden West Senior Living 2017-04-03T17:01:19+00:00

The Towers Application for Residency

* Indicates a required field.

Date: *

Applicant(s) Information:

First Applicant's Name: *    Date of Birth: *

Second Applicant's Name:    Date of Birth:

Address: *     

Telephone: *  


Marital Status: * SingleMarriedPartneredDivorcedWidowed

Ethnicity: * Hispanic or LatinoNon-Hispanic or LatinoI prefer not to disclose

Racial Category (check all that apply): * American Indian or Alaska NativeAsianAfrican AmericanHawaiian or Pacific IslanderCaucasianI prefer not to disclose

Do you currently: *   OwnRentLive in a retirement communityLive with family

Present Landlord or Mortgage Company:                    Phone:

Monthly Rent/Mortgage Payment:               Date of Move-In:

How soon are you contemplating a move? *  ASAP3-6 months6-12 months1-2 yearsUnknown

Will you be parking a vehicle on the property? *  YesNo

Do you own a pet? *  YesNo     Breed:    Weight:

Do you currently receive housing assistance? (i.e. Section 8) *   YesNo

Do you currently live in subsidized housing? *   YesNo

How did you hear about Golden West?   

Annual Income Information:

Wages, Commissions, Fees Received: * $   
Pension, Retirement, Annuity: * $   
Social Security: * $   
Old Age Assistance: * $   
Rents or Royalties Received: * $   
Interest on Savings Accounts, Etc.: * $   
Dividends Received on Stocks, Bonds, Mutual Funds: * $   
Other Income: * $   
Total Annual Income: * $   

* Golden West is required by the State of Colorado and City of Boulder to collect copies of income tax returns from residents and if not required to file a tax return, other third party verification of income must be provided such as Social Security statement and/or bank statements.

Contact Information:

Alternative Contact:      Relationship:  

Address:                             Telephone:  

Apartment Request:

Please select the type of apartment you would prefer studio, one-bedroom or both. Keep in mind that very limited preferences can prolong the waiting time.

Studio Apartment:

1st Available Either TowerCentral Tower EastCentral Tower SE CornerCentral Tower West
Central Tower SW CornerSouth Tower NorthSouth Tower South
South Tower East EndSouth Tower West EndSouth Tower SE Corner

One Bedroom Apartment:

1st Available Either TowerCentral Tower EastCentral Tower West
Central Tower NW CornerCentral Tower NE CornerSouth Tower NW Corner
South Tower SW CornerSouth Tower North

Would you like to request a certain floor?   

Any other requests?   

Credit References:

Bank Name: *    Phone: *

Address: *         Checking Account Number: *

List all credit obligations with minimum monthly payment: *

Have any of the applicants broken a lease? * YesNo

Declared bankruptcy? * YesNo

Criminal History:

Have any of the applicants ever been convicted of a felony? * YesNo

Have any been convicted of a violent crime? * YesNo

Please type the code below.