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Assistance for Housing

Neighborhood Homes Preliminary Application

"*" indicates required fields

THIS IS ONLY A PRELIMINARY APPLICATION that will be used to place your name on the above WAITING LIST. Once your name comes to the top of the waiting list, we will contact you regarding the next step in the application process. You can expect to receive a letter from us acknowledging receipt of your preliminary application and a preliminary determination of your eligibility.

Contact Information

Name*

First Last

Current Address*

Street Address Apt # City State ZIP Code

Home Phone*

Cell Phone

Email*

Number of Occupants (Including Yourself)*

* include yourself

Number of Bedrooms Wanted*

Date Needed*

MM slash DD slash YYYY

How did you hear about us?

Are you disabled?*

Yes

Are you a US Citizen or Eligible Non-citizen?*

Yes

Are you a veteran?*

Yes

Is the head of household a full-time or part-time student?*

Yes

Property Preference*

Occupants

List yourself and each person who will be living with you.

Click the (+) sign on the right to add additional family members*

Last Name

First Name

Middle Initial

Birthdate

Age

Sex

SSN

Gross Monthly Income

Source of Income

(The following information is being collected to assure compliance with Fair Housing & Equal Opportunity rules.)

Ethnicity of Head of Household (Optional)

Hispanic or Latino

Not Hispanic or Latino

Race of Head of Household (Optional)

White

Black

Native American/Alaskan Native

Asian/Pacific Islander

Application Certification

I certify that the statements made on this application are true and complete to the best of my knowledge. I understand that false or incomplete information may result in denial of housing assistance. I certify that no member of the household or any guest engages, or will engage in violent or drug-related criminal activity.*

Yes

Applicant Signature*

Name

This field is for validation purposes and should be left unchanged.

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