Washington DC Rental Application

> Provide the property address, desired screening criteria, and fee details, and receive a complete, District of Columbia-compliant rental application form including all required pre-screening disclosures under D.C. Code § 42-3505.10, FCRA authorization, residency/employment/rental history sections, objective screening criteria, fair-housing notice, pets/occupants/vehicles fields, and signature blocks., -

WASHINGTON, D.C. RESIDENTIAL RENTAL APPLICATION

Property Address: [[Property Street Address]], Washington, DC [[ZIP Code]] (the "Premises")

Unit / Apt No.: [[Unit Number or "N/A"]]

Monthly Rent: $[[Proposed Monthly Rent]]

Application Date: [[Application Date]]

Housing Provider / Landlord or Property Manager: [[Housing Provider / Landlord or Property Management Company Name]]

[[Housing Provider Address]], Washington, DC [[ZIP Code]]

Phone: [[Housing Provider Phone]] | Email: [[Housing Provider Email]], -

Pre-Screening Disclosures and Notice (D.C. Code § 42-3505.10(a))

Before you submit any information or pay any fee, please read this required notice.

Pursuant to D.C. Code § 42-3505.10(a), the housing provider provides the following information in writing:

1. Fees and deposits. The only fee charged prior to lease signing is the nonrefundable application / screening fee of $[[Application Fee Amount]] (subject to the statutory maximum published annually by the Rental Housing Commission; $54 for Calendar Year 2026). This fee covers the actual costs of tenant screening (credit, background, reference, and eviction record checks). The fee is non-refundable once screening is conducted. If no screening is performed for any reason, the fee will be refunded within 14 days. No other fees (including holding deposits) may be charged before lease execution, except that a holding deposit may be requested after approval (unless the applicant will pay rent with a government-funded voucher, in which case no holding deposit may be required).

2. Types of information accessed for tenant screening. Credit / consumer report(s), criminal background check, eviction / court record search (limited per law), prior rental / landlord references, employment and income verification, and identification verification.

3. Specific criteria that will result in automatic denial. [[Automatic Denial Criteria]]. Examples include: eviction judgment for possession in favor of a prior landlord within the last 3 years; material misrepresentation on this application; failure to provide required documentation; or a criminal conviction that, after individualized assessment, poses a direct threat to the health, safety, or property of others (per HUD guidance and D.C. law).

4. Additional criteria that may result in denial. [[Additional Denial Criteria]]. Examples include: credit history indicating inability to pay rent (negative items within recent years not adequately explained); insufficient verifiable gross monthly income (less than [[Income Multiplier]] times the monthly rent); negative landlord references for lease compliance or property damage; unresolved debts owed to a prior housing provider or housing authority; or other information directly relevant to fitness as a tenant.

5. Credit or consumer reporting agency. If used: [[Consumer Reporting Agency Name]], [[Consumer Reporting Agency Address Phone Website]]. You have the right to obtain a free copy of any credit or consumer report if an adverse action is taken.

6. Availability of units. [[Unit Availability Information]]. (E.g., the number of rental units that became available for rent each calendar month in the housing provider's prior fiscal year, by bedroom size and rent range, available upon request.)

7. Response timeline. The housing provider will respond with an approval or denial decision within [[Response Timeline Business Days]] business days after receipt of a complete application and fee.

8. Right to dispute. You have the right to dispute the accuracy of any information relied upon or the permissibility of its use (including information based on prohibited criteria), and to receive a written response from the housing provider within 10 days.

9. Refund of unused application fee. See item 1 above.

10. Right to complain. You have the right to file a complaint with the District of Columbia Office of Human Rights (OHR) or pursue a civil action in the Superior Court of the District of Columbia if you believe the housing provider has violated D.C. Code § 42-3505.10.

Portable tenant screening reports. The housing provider may accept a portable tenant screening report (from a consumer reporting agency) if the applicant provides it and the housing provider's policy is disclosed. No fee will be charged to review a qualifying portable report., -

Application Fee

Application / Screening Fee: $[[Application Fee Amount]] (maximum $54 for 2026 per Rental Housing Commission notice under D.C. Code § 42-3505.10(b); confirm current published cap before charging).

Payment Method: [[Check payable to / Online portal / Other accepted method]]

Fee is non-refundable if screening is performed. Refund required within 14 days if screening is not conducted. If you apply for another unit owned or operated by the same housing provider within 30 calendar days, only one application fee will be charged unless additional screening is required., -

Section 1, Applicant Personal / Contact Information and Identification

Primary Applicant

Full Legal Name: [[Applicant 1 Full Legal Name]]

Date of Birth: [[Applicant 1 Date of Birth]]

Social Security Number (required for credit and background screening only; see FCRA authorization below): [[Applicant 1 SSN]]

Driver's License / State ID Number and State: [[Applicant 1 DL or ID Number]], [[Applicant 1 DL State]]

Phone: [[Applicant 1 Primary Phone Number]]

Email: [[Applicant 1 Primary Email Address]]

Current Address (if different from Premises): [[Applicant 1 Current Street Address]], [[Applicant 1 Current City]], [[Applicant 1 Current State]] [[Applicant 1 Current ZIP]]

Co-Applicant / Additional Adult Occupant

Full Legal Name: [[Applicant 2 Full Legal Name]]

Date of Birth: [[Applicant 2 Date of Birth]]

Social Security Number: [[Applicant 2 SSN]]

Driver's License / State ID Number and State: [[Applicant 2 DL or ID Number]], [[Applicant 2 DL State]]

Phone: [[Applicant 2 Phone Number]]

Email: [[Applicant 2 Email Address]]

Relationship to Primary Applicant: [[Applicant 2 Relationship to Primary]], -

Section 2, Residency History (Past 3 Years or Current + 2 Prior Addresses)

Provide complete history. Attach additional pages if more addresses.

Current or Most Recent Residence

Address: [[Current Residence Street Address]], [[Current Residence City]], [[Current Residence State]] [[Current Residence ZIP]]

Dates of Occupancy: [[Current Residence Start Date]] to [[Current Residence End Date]]

Landlord / Property Manager Name: [[Current Residence Landlord Name]]

Landlord Phone / Email: [[Current Residence Landlord Phone or Email]]

Monthly Rent: $[[Current Residence Monthly Rent]]

Reason for Leaving: [[Current Residence Reason for Leaving]]

Previous Residence 1

Address: [[Previous Residence 1 Street Address]], [[Previous Residence 1 City]], [[Previous Residence 1 State]] [[Previous Residence 1 ZIP]]

Dates: [[Previous Residence 1 Start Date]] to [[Previous Residence 1 End Date]]

Landlord Name / Phone / Email: [[Previous Residence 1 Landlord Name or Phone or Email]]

Monthly Rent: $[[Previous Residence 1 Monthly Rent]]

Reason for Leaving: [[Previous Residence 1 Reason for Leaving]]

Previous Residence 2

Address: [[Previous Residence 2 Street Address]], [[Previous Residence 2 City]], [[Previous Residence 2 State]] [[Previous Residence 2 ZIP]]

Dates: [[Previous Residence 2 Start Date]] to [[Previous Residence 2 End Date]]

Landlord Name / Phone / Email: [[Previous Residence 2 Landlord Name or Phone or Email]]

Monthly Rent: $[[Previous Residence 2 Monthly Rent]]

Reason for Leaving: [[Previous Residence 2 Reason for Leaving]], -

Section 3, Employment and Income Verification

Current Employment (Primary Applicant)

Employer / Company: [[Applicant 1 Employer Name]]

Position / Title: [[Applicant 1 Job Title]]

Dates Employed: [[Applicant 1 Employment Start Date]] to Present

Supervisor / HR Contact: [[Applicant 1 Supervisor or HR Name]], [[Applicant 1 Supervisor or HR Phone]], [[Applicant 1 Supervisor or HR Email]]

Gross Monthly Income (base): $[[Applicant 1 Gross Monthly Base Income]]

Other Monthly Income from this employer (overtime, bonuses, commissions, verifiable): $[[Applicant 1 Other Verifiable Monthly Income]]

Current Employment (Co-Applicant, if applicable)

Employer: [[Applicant 2 Employer Name]]

Position: [[Applicant 2 Job Title]]

Gross Monthly Income: $[[Applicant 2 Gross Monthly Income]]

Other Lawful Sources of Income (housing vouchers, SSI, alimony, disability, child support, etc., source of income is a protected class under D.C. law; disclosure is voluntary but helpful for income qualification)

Source 1: [[Other Income Source 1 Description]], Monthly Amount: $[[Other Income Source 1 Amount]]

Source 2: [[Other Income Source 2 Description]], Monthly Amount: $[[Other Income Source 2 Amount]]

Total Estimated Gross Monthly Household Income: $[[Total Gross Monthly Household Income]]

Income Requirement Acknowledgment: I understand that a common objective criterion is gross monthly income of at least [[Income Multiplier]] times the monthly rent (or other disclosed multiple). All lawful sources of income will be considered equally.

Proof of Income to be Attached: Recent pay stubs (last [[Number of Pay Stubs Required]] ), W-2s or tax returns, benefit award letters, or employer verification form., -

Section 4, Rental History and Landlord References

Previous Landlord Reference 1 (most recent prior to current)

Landlord Name: [[Previous Landlord 1 Name]]

Property Address: [[Previous Landlord 1 Property Address]]

Phone / Email: [[Previous Landlord 1 Phone or Email]]

Dates Rented: [[Previous Landlord 1 Dates Rented]]

Monthly Rent: $[[Previous Landlord 1 Monthly Rent]]

Did you receive full security deposit return? [[Previous Landlord 1 Deposit Return Status]]

Any disputes or damages claimed? [[Previous Landlord 1 Disputes or Damages Details]]

Previous Landlord Reference 2

Landlord Name: [[Previous Landlord 2 Name]]

Property Address: [[Previous Landlord 2 Property Address]]

Phone / Email: [[Previous Landlord 2 Phone or Email]]

Dates Rented: [[Previous Landlord 2 Dates Rented]]

Monthly Rent: $[[Previous Landlord 2 Monthly Rent]]

Deposit return / disputes: [[Previous Landlord 2 Disputes or Damages Details]]

Personal / Professional Reference (non-family, non-landlord)

Name: [[Personal Reference Name]]

Relationship: [[Personal Reference Relationship]]

Phone / Email: [[Personal Reference Phone or Email]], -

Section 5, Occupants, Pets, Vehicles, and Other

All Proposed Occupants (including children)

(Attach additional sheet or list more as needed: [[Additional Occupants]])

Pets (including emotional support / service animals, reasonable accommodations required by law)

Will you have pets? [[Yes / No]]

Type / Breed / Weight / Number: [[Details]]

Service or assistance animal? [[Yes, describe needed accommodation / No]]

Vehicles

Number of vehicles: [[Number]]

Make / Model / Year / License Plate for each: [[Details]]

Smoking Policy Preference / Disclosure: [[Non-smoker / Smoker, type]]

Other Requested Amenities / Special Needs: [[Parking, storage, accessibility features, etc.]], -

Section 6, Screening Criteria (Objective and Consistently Applied)

The housing provider uses the following objective, uniformly applied criteria for all applicants. These criteria comply with the Fair Housing Act, D.C. Human Rights Act, HUD guidance on criminal screening, and D.C. Code § 42-3505.10 (no adverse action based solely on credit score; limited look-back on certain eviction filings).

Equal Application. These criteria are applied the same way to every applicant. Source of income (including government vouchers) will not be used as a basis for denial., -

Section 7, SSN / ID, Consent, Authorization for Background and Credit Check (FCRA Disclosure)

Fair Credit Reporting Act (FCRA) Disclosure and Authorization

In connection with this application for housing, the housing provider may obtain a consumer report (credit report) and/or an investigative consumer report (including background check, rental history, employment, and criminal records) from a consumer reporting agency. The report(s) will be used solely for tenant screening and housing eligibility purposes.

You have the right, under the FCRA (15 U.S.C. § 1681 et seq.), to:

• Know whether a consumer report was obtained.
• Receive a free copy of any consumer report if an adverse action is taken based in whole or in part on the report (within 60 days of the adverse action notice).
• Dispute inaccurate information in the report directly with the consumer reporting agency.

The housing provider will also comply with D.C. Code § 42-3505.10 requirements for adverse action notices (specific grounds, free copy/summary of third-party information, dispute rights, and OHR complaint rights).

Authorization and Release

I/We authorize the housing provider, its agents, and any consumer reporting agency to obtain consumer reports, credit reports, background checks, criminal records, eviction records, employment verification, income verification, and landlord references for the purpose of evaluating this rental application.

I/We authorize all employers, landlords, financial institutions, and other persons or entities to release any and all information requested for this purpose.

I/We certify that all information provided in this application is true, complete, and accurate to the best of my/our knowledge. I/We understand that any material misrepresentation or omission may result in denial of the application or, if a lease is executed, termination of the tenancy and forfeiture of any fees or deposits.

Applicant 1 Signature / Authorization

Signature: ___________________________________________ Date: [[Date]]

Printed Name: [[Applicant 1 Full Legal Name]]

Applicant 2 Signature / Authorization (if applicable)

Signature: ___________________________________________ Date: [[Date]]

Printed Name: [[Applicant 2 Full Legal Name]], -

Section 8, Fair Housing Nondiscrimination Notice (Federal FHA + D.C. Human Rights Act)

The housing provider complies with the federal Fair Housing Act (42 U.S.C. § 3601 et seq.) and the District of Columbia Human Rights Act (D.C. Code § 2-1402.21 et seq.).

It is unlawful to discriminate in the sale, rental, or financing of housing, or in the provision of brokerage or appraisal services, on the basis of:

• Race, color, religion, national origin, sex, familial status, or disability (federal)
• Source of income (including housing choice vouchers / Section 8 and other lawful income sources, explicitly protected in D.C.)
• Sexual orientation, gender identity or expression, age, marital status, personal appearance, family responsibilities, political affiliation, matriculation, place of residence or business, status as a victim of an intrafamily offense, genetic information, or any other characteristic protected by D.C. or federal law.

The housing provider does not discriminate on any of these bases. All screening criteria are applied consistently and without regard to protected characteristics. Reasonable accommodations and modifications will be provided for applicants and tenants with disabilities upon request.

If you believe you have experienced discrimination, you may file a complaint with the D.C. Office of Human Rights (https://ohr.dc.gov) or the U.S. Department of Housing and Urban Development (HUD)., -

Section 9, Signature and Acknowledgment

By signing below, I/we:

• Confirm that I/we have read, understand, and received the Pre-Screening Disclosures and Notice.
• Agree to pay the application fee as stated.
• Authorize the screening described above.
• Certify the truth of all statements in this application.
• Acknowledge that this is an application only and does not create a tenancy or obligation to lease.

Primary Applicant

Signature: ___________________________________________ Date: [[Date Signed]]

Printed Name: [[Applicant 1 Full Legal Name]]

Co-Applicant / Additional Adult

Signature: ___________________________________________ Date: [[Date Signed]]

Printed Name: [[Applicant 2 Full Legal Name]], -

Landlord / Housing Provider Use Only (Do Not Provide to Applicant)

Date Application Received: [[Date]]

Fee Received: $[[Amount]] Method: [[Method]] Receipt No.: [[Number]]

Screening Ordered: [[Date]] Agency: [[Name]]

Decision Date: [[Date]]

Decision: ☐ Approved ☐ Denied ☐ Approved with conditions (see below)

Adverse Action Notice Sent (if applicable): [[Date]] Method: [[Certified Mail / Email / Other]]

Grounds for Denial / Conditions (specific, not based on prohibited criteria): [[Detailed grounds, consistent with disclosed criteria]]

Copy of third-party reports provided with adverse action notice? [[Yes / N/A]]

Notes:

[[Landlord Notes / File Location]]

Processed By: [[Agent Name / Title]] Date: [[Date]], -

Attachments Checklist (Applicant to Provide)

• [ ] Valid government-issued photo ID (driver's license, state ID, or passport) for each adult applicant
• [ ] Proof of income (pay stubs, tax returns, benefit statements, employer letter, or voucher documentation)
• [ ] Completed application with all sections filled
• [ ] Application fee payment
• [ ] Portable screening report (if electing to provide one)
• [ ] Other: [[Additional Attachments Description]], -

Disclaimer and Sources

Template, not professional legal advice. This is a sample Washington, D.C. rental application form incorporating required disclosures and procedures under current District of Columbia law. It is not a substitute for advice from a licensed D.C. attorney. Housing law, fee caps, screening rules, and protected classes are subject to change. Verify all information against primary sources and current Rental Housing Commission publications before use. Invented or variable values appear only as `[[merge fields]]`.

Sources (as of 2026-06-23):
- D.C. Code § 42-3505.10 (Tenant screening, pre-notice requirements, application fee cap and adjustments, prohibited inquiries, adverse action notice, dispute rights, penalties)
- D.C. Code § 42-3501.03 (definitions, including application fee)
- Rental Housing Commission 2026 CPI Application Fee Notice ($54 maximum for Calendar Year 2026)
- D.C. Code § 2-1402.21 et seq. (D.C. Human Rights Act, source of income and other protected classes)
- Fair Housing Act, 42 U.S.C. § 3601 et seq.
- HUD Guidance on Application of the Fair Housing Act to the Use of Criminal Records (2016) (individualized assessment)
- HUD Guidance on Application of Fair Housing Act Standards to the Use of Criminal Records by Providers of Housing and Real Estate-Related Transactions (2016)
- D.C. Office of the Tenant Advocate and Rental Housing Commission resources on tenant screening and fees

FCRA Notice. Consumer reporting is governed by the federal Fair Credit Reporting Act, 15 U.S.C. § 1681 et seq. This template includes the required disclosures and authorizations., -

*End of Washington DC Rental Application form. Housing provider should retain a copy and provide the applicant a copy of the completed form and all required notices upon request.*