HURON HOMELESS HELP PROGRAM POLICY STATEMENT - TERMINATION OF ASSISTANCE

Size: px
Start display at page:

Download "HURON HOMELESS HELP PROGRAM POLICY STATEMENT - TERMINATION OF ASSISTANCE"

Transcription

1 HURON HOMELESS HELP PROGRAM POLICY STATEMENT - TERMINATION OF ASSISTANCE At any time, the Huron Homeless HELP Program may immediately terminate assistance to a participating family if any member of the family commits: 1) Drug-related criminal activity; or 2) Violent criminal activity. Drug-related criminal activity includes illegal use, possession or distribution of a controlled substance as well as keeping a place for the sale and use of a controlled substance. Violent criminal activities include but are not limited to battery, murder, rape, first-degree arson, domestic or sexual abuse. In determining whether to deny or terminate assistance based on drug-related criminal activity or violent criminal activity, the Huron Homeless HELP Program may terminate assistance if the preponderance of evidence indicates that a family member has engaged in such activity, regardless of whether the family member has been arrested or convicted. All adult members listed on an application are required to provide the Huron Homeless HELP Program a signed, written authorization to obtain criminal records in accordance with 24 CFR IF HOUSING ASSISTANCE IS TERMINATED FOR DRUG-RELATED CRIMINAL ACTIVITY, YOU WILL BE BARRED FROM RECEIVING HOUSING ASSISTANCE FOR A PERIOD OF THREE (3) YEARS. IF YOU ARE CONVICTED OF THE MANUFACTURE/PRODUCTION/SALE OF METHAMPHETAMINE (SPEED), YOU WILL BE IMMEDIATELY TERMINATED AND PERMANENTLY DENIED HOUSING ASSISTANCE UNDER THE HURON HOMELESS HELP PROGRAM WITHOUT THE BENEFIT OF AN INFORMAL REVIEW. Additional grounds for termination of assistance include: 1) If the family violates any family obligations under the program, including but not limited to failure to report changes to income and/or household composition. 2) If the family fails to cooperate with the HELP Program case manager. 3) If any adult member of the household commits fraud, bribery or any other corrupt or criminal act in connection with any federal housing program. 4) If the applicant has violated any family obligation relative to the Huron Homeless HELP Program during a previous participation in the Huron Homeless HELP Program. 5) If a family fails to keep its utility bills current which results in the utilities being shut off. 6) If the family commits any serious or repeated violation of the lease, as in failure to pay the family s rental obligation on time. 7) If a family has engaged in, or threatened abusive or violent behavior toward Huron Homeless HELP Program personnel. THE HURON HOMELESS HELP PROGRAM WILL DO FOLLOW-UP REVIEWS WITH ANY APPLICANTS WHO ARE PLACED IN PERMANENT HOUSING IN AN EFFORT TO PREVENT CHRONIC HOMELESSNESS. IN EACH OF THE CASES IDENTIFIED IN THIS SECTION, THE APPLICANT OR PARTICIPANT WILL BE NOTIFIED OF THEIR RIGHT TO AN INFORMAL REVIEW, IN ACCORDANCE WITH THE ADMINISTRATIVE POLICES OF THE HURON HOMELESS HELP PROGRAM. I have read the foregoing Policy Statement regarding Termination of Assistance under the Huron Homeless HELP Program and have received a copy thereof. I understand that my assistance can or will be terminated in the event I breach any of the foregoing conditions. Client Date

2

3

4

5

6 AUTHORIZATION FOR RELEASE OF INFORMATION USE FOR ALL PURPOSES CONSENT I authorize and direct any Federal, State, or local agency, organization, business, or individual to release to Huron Housing and Redevelopment Authority (HRA) any information or materials needed to complete and verify my application for participation, and/or to maintain my continued assistance under the Section 8 Program, and/or other housing assistance programs administered by the HRA. I understand and agree that this Authorization or the information obtained with its use may be given to and used by the Department of Housing and Urban Development (HUD) and USDA Rural Development in administering and enforcing program rules and policies. In addition, I authorize and consent to the exchange of information between the HRA and supportive service agencies from whom I am receiving services, i.e. Community Counseling Services, Huron Area Center for Independence, Department of Social Services, Cornerstones Career Learning Center, Inc., concerning my family s circumstances, and/or other matters relating to my disability and/or medical condition. INFORMATION COVERED I understand that, depending on program policies and requirements, previous or current information regarding me or my household may be needed. Verification and inquires that may be requested include but are not limited to: Identity and Marital Status Medical or Child Care Allowances Residences and Rental Activity Employment, Income, and Assets Credit and Criminal Activity I understand that this Authorization cannot be used to obtain any information about me that is not pertinent to my eligibility for and continued participation in a housing assistance program. GROUPS OR INDIVIDUALS THAT MAY BE ASKED The groups or individuals that may be asked to release the above information (depending on program requirements) include but are not limited to: Previous Landlords (including Public Housing Agencies) Courts and Post Offices Schools and Colleges Law Enforcement Agencies Support and Alimony Providers Retirement Systems Welfare Agencies Past and Present Employers Credit Providers and Credit Bureaus State Unemployment Agencies Social Security Administration Medical and Child Care Providers Veterans Administration Banks and other Financial Institutions Utility Companies CONDITIONS I agree that a photocopy of this Authorization may be used for the purposes stated above. The original of this Authorization is on file with the HRA and will stay in effect for a period of fifteen (15) months from the date signed. I understand I have a right to review my file and correct any information that I can prove is incorrect. Head of Household [State(s) of Residency In Past 3 Years] Date Spouse [State(s) of Residency In Past 3 Years] Date Adult Member Signature [State(s) of Residency In Past 3 Years] Date

AUTHORIZATION FOR RELEASE OF INFORMATION CONSENT I authorize and direct any Federal, State or local agency organization, business, or individuals to r

AUTHORIZATION FOR RELEASE OF INFORMATION CONSENT I authorize and direct any Federal, State or local agency organization, business, or individuals to r AUTHORIZATION FOR RELEASE OF INFORMATION CONSENT I authorize and direct any Federal, State or local agency organization, business, or individuals to release to Scott County Community Development Agency

More information

Mt. Shasta Security Deposit Assistance Program

Mt. Shasta Security Deposit Assistance Program Mt. Shasta Security Deposit Assistance Program The Security Deposit Assistance Program (SDAP) is a Community Development Block Grant (CDBG) funded program for households living within the city limits of

More information

Brainerd Housing and Redevelopment Authority 324 East River Road Brainerd, MN PHONE: (218) FAX: (218)

Brainerd Housing and Redevelopment Authority 324 East River Road Brainerd, MN PHONE: (218) FAX: (218) FOR OFFICE USE ONLY: DATE: TIME: INCOME: Bedroom size: North Star Valley Trail Scattered Sites Court Records Check Completed Initial Eligibility Yes No Basis for Denial: 2017 Brainerd Housing and Redevelopment

More information

*161* Housing Authority of the City of Vineland Administrative Offices 191 W. Chestnut Avenue Vineland, NJ Fax

*161* Housing Authority of the City of Vineland Administrative Offices 191 W. Chestnut Avenue Vineland, NJ Fax *161* Housing Authority of the City of Vineland Administrative Offices 191 W. Chestnut Avenue Vineland, NJ 08360 856-691-4099 Fax 856-691-8404 ***Accepting Applications for Oakview Apartments 2, 3, & 4

More information

405 SW 6 th St Redmond, OR Phone: Fax: SELF DECLARATION FORM

405 SW 6 th St Redmond, OR Phone: Fax: SELF DECLARATION FORM 405 SW 6 th St Redmond, OR 97756 Phone: 541-923-1018 Fax: 541-923-6441 SELF DECLARATION FORM Instructions for completing this form: Complete this form IN INK. Complete all blanks. All adult members in

More information

Housing Authority of the City of Vineland Administrative Offices 191 W. Chestnut Avenue Vineland, NJ Fax

Housing Authority of the City of Vineland Administrative Offices 191 W. Chestnut Avenue Vineland, NJ Fax Housing Authority of the City of Vineland Administrative Offices 191 W. Chestnut Avenue Vineland, NJ 08360 856-691-4099 Fax 856-691-8404 ***Accepting Applications for 0 and one bedrooms only*** Applications

More information

RECEIVED BY THE HRA Date: Time: APPLICATION FOR PUBLIC AND SECTION 8 NEW CONSTRUCTION HOUSING ASSISTANCE Equal Housing Opportunity

RECEIVED BY THE HRA Date: Time: APPLICATION FOR PUBLIC AND SECTION 8 NEW CONSTRUCTION HOUSING ASSISTANCE Equal Housing Opportunity RECEIVED BY THE HRA Date: Time: APPLICATION FOR PUBLIC AND SECTION 8 NEW CONSTRUCTION HOUSING ASSISTANCE Equal Housing Opportunity Applicant Name: First Middle Initial Last Co-Applicant: First Middle Initial

More information

APPLICATION SCREENING COVER NOTICE

APPLICATION SCREENING COVER NOTICE APPLICATION SCREENING COVER NOTICE An application fee of $25.00 is charged per person. NO CASH PLEASE (check or money order only). The application fee covers the cost of checking landlord, credit, employment

More information

Prairie Harvest Mental Health Occupancy Application **IMPORTANT INFORMATION** READ & KEEP THIS PAGE

Prairie Harvest Mental Health Occupancy Application **IMPORTANT INFORMATION** READ & KEEP THIS PAGE Prairie Harvest Mental Health Occupancy Application 1 An Equal Housing Opportunity Provider To qualify for housing from Prairie Harvest Mental Health, the applicant must meet the following criteria: Applicants

More information

In order to process your application, we find it necessary to charge an application fee. The fee is $17 for one adult or $34 for two or more adults.

In order to process your application, we find it necessary to charge an application fee. The fee is $17 for one adult or $34 for two or more adults. Dear Applicant: In order to process your application, we find it necessary to charge an application fee. The fee is $17 for one adult or $34 for two or more adults. This is a NON-REFUNDABLE FEE, even if

More information

NSP Eligibility Application

NSP Eligibility Application NSP Eligibility Application The City of Mesquite has funded the purchase and rehabilitation of foreclosed upon or vacant single-family homes using a Neighborhood Stabilization Program (NSP) grant received

More information

Tenant Data Release of Information

Tenant Data Release of Information TH E MUNICIPAL HOUS I NG AGENCY Tenant Data Release of Information For: Applicant's Name Social Security Number I hereby authorize the landlord or landlord's agents to verify the information on the application.

More information

NOTE: THIS FORM IS NOT A FAXABLE FORM, ORIGINAL APPLICATION IS REQUIRED.

NOTE: THIS FORM IS NOT A FAXABLE FORM, ORIGINAL APPLICATION IS REQUIRED. DUNN COUNTY HOUSING AUTHORITY 1421 Stout Road, Menomonie, WI 54751 PLEASE PRINT Phone 715-235-4511 ext. 204 Fax 715-235-9241 OFFICE USE ONLY Application Received on: Date Time AM/PM PHA Representative:

More information

Emergency Housing Assistance Application

Emergency Housing Assistance Application Applicant Name: Issued From: ******OFFICE USE ONLY****** DO NOT WRITE IN THIS SPACE Date Submitted: Time Submitted: Received by: 2015-2016 Emergency Housing Assistance Application Please make sure your

More information

APPLICATION FOR APARTMENTS. NAME: Last First Middle. ADDRESS: Street City State Zip Code TELEPHONE #: HOME WORK MESSAGE. * Social Security #

APPLICATION FOR APARTMENTS. NAME: Last First Middle. ADDRESS: Street City State Zip Code TELEPHONE #: HOME WORK MESSAGE. * Social Security # 1 APPLICATION FOR APARTMENTS NAME: Last First Middle ADDRESS: Street City State Zip Code TELEPHONE #: HOME WORK MESSAGE APARTMENT SIZE REQUESTED Directions to Applicant: Answer all questions on this application.

More information

Denial or Termination of Assistance CHAPTER 12 DENIAL OR TERMINATION OF ASSISTANCE

Denial or Termination of Assistance CHAPTER 12 DENIAL OR TERMINATION OF ASSISTANCE CHAPTER 12 DENIAL OR TERMINATION OF ASSISTANCE 12.0 INTRODUCTION The HA may deny assistance to a family or to the requested addition of a household member or terminate assistance to a family because of

More information

APPLICANT NAME: First Middle Last. CO-APPLICANT NAME: First Middle Last CURRENT ADDRESS: APT. #: P.O. BOX #

APPLICANT NAME: First Middle Last. CO-APPLICANT NAME: First Middle Last CURRENT ADDRESS: APT. #: P.O. BOX # Which property are you interested in? APARTMENT NAME I/WE WISH TO MOVE IN WITH A CURRENT RESIDENT NAME: APT#: Revision 10/17 CITY ALL INCOMPLETE APPLICATIONS WILL BE RETURNED Please complete all areas

More information

Household, Income and Asset Information This application MUST BE FULLY COMPLETE. Applicant Name (this is you) City/ Town: State: Zip Code:

Household, Income and Asset Information This application MUST BE FULLY COMPLETE. Applicant Name (this is you) City/ Town: State: Zip Code: Falmouth Housing Corporation Falmouth Community, LLC 704 FHC LLC FHC Edgerton Drive, Inc. 704 Main LLC 704 Main Street Falmouth, MA 02540 Tel. (508)540-4009 Fax. (508)548-6329 Household, Income and Asset

More information

THE LEGACY APARTMENTS RESIDENT SELECTION PLAN AND CRITERIA FOR LOW INCOME HOUSING TAX CREDIT UNITS ACC-ASSISTED UNITS Revised 4/21/2008

THE LEGACY APARTMENTS RESIDENT SELECTION PLAN AND CRITERIA FOR LOW INCOME HOUSING TAX CREDIT UNITS ACC-ASSISTED UNITS Revised 4/21/2008 THE LEGACY APARTMENTS RESIDENT SELECTION PLAN AND CRITERIA FOR LOW INCOME HOUSING TAX CREDIT UNITS ACC-ASSISTED UNITS Revised 4/21/2008 Applicants for admittance to Low Income Housing Tax Credit Units

More information

Housing Choice Voucher Program (Section 8) Change Form

Housing Choice Voucher Program (Section 8) Change Form QC Date: LHA Official Proceed to Process by Case Worker Lakeland Housing Authority 430 Hartsell Ave No Action Lakeland FL 33815 Required Tel: 863-687-2911 Housing Choice Voucher Program (Section 8) Change

More information

FOR RENTAL ASSISTANCE BENEFITS 433 BALTIMORE AVENUE, CLARKSBURG, WV PHONE (304) FAX (304)

FOR RENTAL ASSISTANCE BENEFITS 433 BALTIMORE AVENUE, CLARKSBURG, WV PHONE (304) FAX (304) For PHA use only: Date: Time: Veteran? CLARKSBURG-HARRISON REGIONAL HOUSING AUTHORITY PERSONAL DECLARATION FOR RENTAL ASSISTANCE BENEFITS 433 BALTIMORE AVENUE, CLARKSBURG, WV 26301 PHONE (304) 623-3322

More information

COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME:

COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME: SUBJECT: APPLICANT FOR RESIDENCY TAX CREDIT COMMUNITIES COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME: HOW DID YOU HEAR ABOUT US? APARTMENT SIZE: APPLICANT NAME (FIRST, MIDDLE, LAST): CURRENT ADDRESS:

More information

Hough Heritage. Application Instructions. 2. Use only black or blue ink. Colored inks, markers or pencil are not permitted.

Hough Heritage. Application Instructions. 2. Use only black or blue ink. Colored inks, markers or pencil are not permitted. Hough Heritage Application Instructions 1. Please print all answers. 2. Use only black or blue ink. Colored inks, markers or pencil are not permitted. 3. If a question does not apply, please write N/A

More information

COMPANY NAME: WinnResidential Phone: (202) Third Street SE, Suite 200 Fax: (202) Washington, DC 20032

COMPANY NAME: WinnResidential Phone: (202) Third Street SE, Suite 200 Fax: (202) Washington, DC 20032 Elementary, Middle or High School College, University, or Trade School COMPANY NAME: WinnResidential Phone: (202) 561-8600 4319 Third Street SE, Suite 200 Fax: (202) 516-8054 Washington, DC 20032 Email:

More information

PREAPPLICATION NOTE: NO PETS ALLOWED WITHOUT MANAGEMENT APPROVAL. Applicant Name First Middle Last State ID # State

PREAPPLICATION NOTE: NO PETS ALLOWED WITHOUT MANAGEMENT APPROVAL. Applicant Name First Middle Last State ID # State PREAPPLICATION NOTE: NO PETS ALLOWED WITHOUT MANAGEMENT APPROVAL Contact Information: Applicant Name First Middle Last State ID # State Co- Applicant Name First Middle Last State ID # State Email Phone

More information

Caseville Housing Commission

Caseville Housing Commission OAKWOOD Senior Citizen Housing 6905 N. Caseville Road Caseville, MI 48725 989.856.3323 Fax 989.856.2552 casevillehousing@comcast.net Caseville Housing Commission Chairperson: Sharon Kelly Commissioners:

More information

APPLICATION FOR RESIDENCY

APPLICATION FOR RESIDENCY Please note: Each adult 18 years of age and older needs to complete a separate application unless a married couple. APPLICANT INFORMATION Name: Spouse: Current Address: Telephone: Email: Bedroom Size Requested:

More information

CARPENTER MANAGEMENT COMPANY, INC. APPLICATION INSTRUCTIONS

CARPENTER MANAGEMENT COMPANY, INC. APPLICATION INSTRUCTIONS , INC. APPLICATION INSTRUCTIONS DATE: KEEP THIS PAGE FOR YOUR RECORDS To properly process your application, we must run a credit check and national criminal search, which includes a national sex offender

More information

INCOME CHANGE REPORTING FORM. Note: Your assistance may be terminated if you do not complete and return this form within 10 business days from

INCOME CHANGE REPORTING FORM. Note: Your assistance may be terminated if you do not complete and return this form within 10 business days from INCOME CHANGE REPORTING FORM Add New Income Loss of Income Note: Your assistance may be terminated if you do not complete and return this form within 10 business days from the receipt or loss of income.

More information

Personal Declaration of Eligiblity

Personal Declaration of Eligiblity To be completed by Housing Authority of Interview / / Initial Annual Interim Move Name of Tenant: Interviewed by: _ I. Contact Information Name: Address: Email Address: II. Marital Status Marital Status:

More information

GUADALUPE APARTMENTS APPLICATION FOR

GUADALUPE APARTMENTS APPLICATION FOR APPLICATION FOR GUADALUPE APARTMENTS Kind of Housing LIHTC Studio, 1, and 2 bedroom apartments for people at or below 30% of area median income Section 8 vouchers for each unit provides rent to based on

More information

Last Name First Name Middle. Address Number & Street City State Zip Code. Date of Birth Applicant Co-applicant / / / / Month Day Year Month Day Year

Last Name First Name Middle. Address Number & Street City State Zip Code. Date of Birth Applicant Co-applicant / / / / Month Day Year Month Day Year PARKVIEW APARTMENTS HOUSING APPLICATION Mr. Ms. Miss Date: Mrs. Mr. & Mrs. Last Name First Name Middle Address Number & Street City State Zip Code ( ) ( ) Home Phone Number Alternate Contact Number How

More information

Housing Authority of the City of Atchison, Kansas 103 South 7 th Street, Atchison, Kansas Phone: Fax:

Housing Authority of the City of Atchison, Kansas 103 South 7 th Street, Atchison, Kansas Phone: Fax: Housing Authority of the City of Atchison, Kansas 103 South 7 th Street, Atchison, Kansas 66002 Phone: 913-367-3323 Fax: 913-367-6002 NOTICE TO ALL ADULT MEMBERS OF FAMILIES APPLYING FOR PUBLIC HOUSING

More information

Yakama Nation Housing Authority Elder Minor Home Repair Program

Yakama Nation Housing Authority Elder Minor Home Repair Program Applicant Name: ******OFFICE USE ONLY****** DO NOT WRITE IN THIS SPACE Date Submitted: Time Submitted: Received by: Yakama Nation Housing Authority Elder Minor Home Repair Program Please make sure your

More information

We Do Business in Accordance to the Federal Fair Housing Law

We Do Business in Accordance to the Federal Fair Housing Law PLEASE COMPLETE IN FULL Housing Authority of the City of Fort Myers Affordable Housing - HORIZONS APARTMENTS 5360 Summerlin Road, Fort Myers, FL 33919 Telephone (239) 936-6760 Fax (239) 936-6761 TDD (239)

More information

Property Management, Inc.

Property Management, Inc. EQUAL HOUSING O P P O R T U N I T Y Justus Property Management, Inc. RENTAL APPLICATION Marketing info: How did you hear about the property? Please include a $16.00 fee for each adult household member.

More information

Student Rental Assistance Program Application Packet & Checklist

Student Rental Assistance Program Application Packet & Checklist Student Rental Assistance Program Application Packet & Checklist The following is a list of information necessary to properly document your application file. Some items may not apply to you. The sooner

More information

Blackfeet Housing General Application ITEMS NEEDED FOR APPLICATION THE FOLLOWING ITEMS NEED TO BE WITH YOUR APPLICATION BEFORE YOU TURN IT IN:

Blackfeet Housing General Application ITEMS NEEDED FOR APPLICATION THE FOLLOWING ITEMS NEED TO BE WITH YOUR APPLICATION BEFORE YOU TURN IT IN: Blackfeet Housing General Application INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED INSTRUCTIONS ON COMPLETING YOUR APPLICATION ITEMS NEEDED FOR APPLICATION THE FOLLOWING ITEMS NEED TO BE WITH YOUR APPLICATION

More information

Housing Authority of the Town of Beaufort 716 Mulberry Street Beaufort, NC (252)

Housing Authority of the Town of Beaufort 716 Mulberry Street Beaufort, NC (252) EQUAL HOUSING OPPORTUN!TY Housing Authority of the Town of Beaufort 716 Mulberry Street Beaufort, NC 28516 (252)-728-3226 Applicants MUST have ALL reguired documents listed below at interview or the application

More information

SUBJECT: APPLICATION FOR RESIDENCY

SUBJECT: APPLICATION FOR RESIDENCY SUBJECT: APPLICATION FOR RESIDENCY COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME: HOW DID YOU HEAR ABOUT US? APPLICANT NAME: APARTMENT SIZE: CURRENT ADDRESS: CITY STATE, ZIP: HOME PHONE #: WORK

More information

YWCA OF WESTERN MASSACHUSETTS Supportive Housing Program APPLICATION FOR HOUSING

YWCA OF WESTERN MASSACHUSETTS Supportive Housing Program APPLICATION FOR HOUSING YWCA OF WESTERN MASSACHUSETTS Supportive Housing Program APPLICATION FOR HOUSING Program Description The YWCA Supportive Housing Program is an 18-24 month supportive housing program that is designed to

More information

Verification of Disability

Verification of Disability Rent Assistance Department 135 SW Ash Street Portland, OR 97204-3541 TEL: 503.802.8333 FX: 503.802.8330 TTY: 503.802.8554 Verification of Disability Instructions: A qualified professional must complete

More information

Tax Credit Housing Application

Tax Credit Housing Application Trailside Heights I, II, III/Lumen Park T: 907.222.1733 F: 907.222.1738 TTY: 711 Trailside2@VOA.org www.voa.org/trailside Heights www.voa.org/lumen park Instructions for completing the application: Please

More information

1 of 26 DOCUMENTS. NEW JERSEY ADMINISTRATIVE CODE Copyright (c) 2007 by the New Jersey Office of Administrative Law

1 of 26 DOCUMENTS. NEW JERSEY ADMINISTRATIVE CODE Copyright (c) 2007 by the New Jersey Office of Administrative Law Page 1 1 of 26 DOCUMENTS Title 5, Chapter 42 -- CHAPTER AUTHORITY: N.J.S.A. 52:27D-287.2. CHAPTER SOURCE AND EFFECTIVE DATE: R.2005 d.152, effective May 16, 2005. See: 37 N.J.R. 165(a), 37 N.J.R. 1775(a).

More information

Winnebago County Housing Authority 3617 Delaware Street Rockford, IL Phone: (815) Fax: (815)

Winnebago County Housing Authority 3617 Delaware Street Rockford, IL Phone: (815) Fax: (815) Winnebago County Housing Authority 3617 Delaware Street Rockford, IL 61102 Phone: (815) 963-2133 Fax: (815) 316-2860 Winnebago County Rental Housing Support Program efficiency-3 bedroom units, which applicants

More information

phone fax

phone fax 480-898-0228 phone 480-898-9007 fax www.affordablerental.org Save the Family's Transitional Program was designed to promote self-sufficiency and stabilize family lifestyles with the community through intensive

More information

801 Penn St., Reading, PA (610) / TTY 711

801 Penn St., Reading, PA (610) / TTY 711 801 Penn St., Reading, PA 19601 (610) 373-1212 / TTY 711 Thank you for your inquiry to Housing Development Corporation MidAtlantic. Our non-profit organization is dedicated to providing residential opportunities

More information

Please make sure your application has all of the items listed in the boxed area complete before turning it into YNHA Weatherization Program.

Please make sure your application has all of the items listed in the boxed area complete before turning it into YNHA Weatherization Program. Applicant Name: YAKAMA NATION HOUSING AUTHORITY Weatherization Application 701 South Camas Avenue - - P.O. Box 156 Wapato, WA 98951-1499 Phone: (509) 877-6171 Ext. 1105 or 1102 Fax: (509) 877-6317 Toll

More information

Instructions: Please follow carefully - Incomplete applications will be returned

Instructions: Please follow carefully - Incomplete applications will be returned North Carolina TTY Relay Service (800) 735-2962 Instructions: Please follow carefully - Incomplete applications will be returned 1. Complete all areas. If an item does not apply to you, mark N/A on that

More information

Housing Choice Voucher Program: Waiting List Information

Housing Choice Voucher Program: Waiting List Information 2605 S Oneida St., Suite 106 Green Bay, WI 54304 (920) 498-3737 Housing Choice Voucher Program: Waiting List Information Income Limits 1 Person 2 Person 3 Person 4 Person 5 Person 6 Person 7 Person 8 Person

More information

Change of Circumstance

Change of Circumstance Received: EXECUTIVE DIRECTOR Ashley Lommers-Johnson Change of Circumstance My housing assistance is (please check one) Section 8 Public Housing All changes reported must be complete, accurate, and reported

More information

APPLICATION PROCESS for RealAmerica Management

APPLICATION PROCESS for RealAmerica Management APPLICATION PROCESS for RealAmerica Management RENTAL GUIDELINES: 1. Falsification of information on an application is basis for denial. 2. All applicants and residents 18 years of age and older must complete

More information

THE HOUSING AUTHORITY

THE HOUSING AUTHORITY THE HOUSING AUTHORITY OF THE CITY OF LAWRENCEVILLE 502 Glenn Edge Drive Lawrenceville, Georgia 30046 www.lawrencevilleha.org Lejla Slowinski Executive Director Phone: (770) 963-4900 LAWRENCEVILLE HOUSING

More information

Birth Date. Social Security Number

Birth Date. Social Security Number AMERICAN RESIDENTIAL INVESTMENT MANAGEMENT RENTAL APPLICATION PARK PLACE APARTMENTS 107 LUXURY LANE KNIGHTDALE NC 27545 Tel: 919-266-1323, Fax: 888-466-0222 http://www.parkplaceknightdale.com MGR. INITIALS

More information

Property Management, Inc. RENTAL APPLICATION Marketing info: How did you hear about the community?

Property Management, Inc. RENTAL APPLICATION Marketing info: How did you hear about the community? EQUAL HOUSING O P P O R T U N I T Y Justus Property Management, Inc. RENTAL APPLICATION Marketing info: How did you hear about the community? Please include an $16.00 fee for each adult household member.

More information

Montgomery County Housing Authority 216 Shelbyville Road, P.O. Box 591 Hillsboro, Illinois (217) ext. 221 or 229

Montgomery County Housing Authority 216 Shelbyville Road, P.O. Box 591 Hillsboro, Illinois (217) ext. 221 or 229 Montgomery County Housing Authority 216 Shelbyville Road, P.O. Box 591 Hillsboro, Illinois 62049 (217) 532-3672 ext. 221 or 229 Office Hours: Monday thru Friday, 8 a.m. to 4:30 p.m. Montgomery County Senior

More information

We Do Business in Accordance to the Federal Fair Housing Law

We Do Business in Accordance to the Federal Fair Housing Law PLEASE COMPLETE IN FULL SW Florida Affordable Choice Foundation, Inc. Application for Covington Meadows Covington Meadows Circle, Lehigh Acres, FL 33936 Telephone (239) 344-3220 Fax (239) 344-3273 TDD

More information

Application for Public Housing

Application for Public Housing Application for Public Housing DATE: TIME: UNIT SIZE: BEDROOM(S) ETHNICITY: General Family Information Legal Name of Head of Household Your Name if Family Head is not present [ ] HISPANIC [ ] NONHIPANIC

More information

Housing Authority for the City of Amery 300 North Harriman Avenue Amery, WI (phone) (fax)

Housing Authority for the City of Amery 300 North Harriman Avenue Amery, WI (phone) (fax) Housing Authority for the City of Amery 300 North Harriman Avenue Amery, WI 54001 715-268-2500 (phone) 715-268-7700 (fax) aha@amerytel.net Office Use Only: (/Time stamp) Programs Applying For: (Check all

More information

I/we am indicating my/our liability insurance election by placing my/our initials on one of the lines below:

I/we am indicating my/our liability insurance election by placing my/our initials on one of the lines below: Acknowledgment of Liability or Property Damage Insurance Requirement By completing this form, I/we acknowledge that I/we understand Sela's requirement of personal liability insurance, or property damage

More information

APPLICATION FOR ASSISTANCE

APPLICATION FOR ASSISTANCE FOR OFFICE USE ONLY BR SIZE APP. APP. TIME PREF PAPERWORK COMPLETE NATIONAL REGISTRY CHECKED EIV DEBTS OWED CHECKED NEWARK HOUSING AUTHORITY 200 DRIVING PARK CIRCLE, P.O. BOX 108 NEWARK, NY 14513 PHONE

More information

VILLAGE OAKS Pre-APPLICATION For Project-Based Section 8 Units Incomplete applications will not be accepted:

VILLAGE OAKS Pre-APPLICATION For Project-Based Section 8 Units Incomplete applications will not be accepted: VILLAGE OAKS Pre-APPLICATION For Project-Based Section 8 Units Incomplete applications will not be accepted: This application is for Project-Based Section 8 (income-based) units at Village Oaks Apartments,

More information

Valley Residential Service (VRS)

Valley Residential Service (VRS) Valley Residential Service (VRS) Rental Housing Application Valley Residential Services (VRS) * 1075 Check Street, Suite 102 * Wasilla, AK 99654 * Phone: (907) 357-0256 * Fax: (907) 357-0368 www.valleyres.org

More information

RESIDENT SELECTION PLAN. The income maximums and minimums are attached and will be posted in the Pacific Meadows Office.

RESIDENT SELECTION PLAN. The income maximums and minimums are attached and will be posted in the Pacific Meadows Office. PACIFIC MEADOWS 5315 CARMEL VALLEY ROAD, CARMEL, CA 93923 TELEPHONE (831) 624-9355 TDD (800) 545-1833 EXT 478 PM-ADMINISTRATOR@ABHOW.COM WWW.PACIFICMEADOWSCARMEL.COM RESIDENT SELECTION PLAN Pacific Meadows

More information

Apple Ridge. C/O Hodges Development Corp 201 Loudon Road, Concord, NH Phone: Fax: (603)

Apple Ridge. C/O Hodges Development Corp 201 Loudon Road, Concord, NH Phone: Fax: (603) Apple Ridge C/O Hodges Development Corp 201 Loudon Road, Concord, NH 03301 Phone: 1-800-742-4686 Fax: (603) 224-6785 Dear Housing Applicant: Thank you for your interest in Hodges Development Corporation,

More information

THE FLATS - Phase II 525 N. Union St., Wilmington, DE (302) TTY 711

THE FLATS - Phase II 525 N. Union St., Wilmington, DE (302) TTY 711 THE FLATS - Phase II 525 N. Union St., Wilmington, DE 19805 (302) 656-2972 TTY 711 Dear Prospective Resident, Thank you for your interest in Housing Development Corporation MidAtlantic, the premier non-profit

More information

Public Housing ACOP Suggested Changes for 2016

Public Housing ACOP Suggested Changes for 2016 Public Housing ACOP Suggested Changes for 2016 Waiting List: Informal Review Current: LHC will only offer informal hearings to applicants for the purpose of disputing denials of admission. Informal Review

More information

Hodges Development Corporation Hodges Properties, Inc Hodges-Portsmouth, LLC Hodges-Pembroke, LLC Instructions: Please follow carefully - Incomplete applications will be returned 1. Complete all areas.

More information

Community Planning and Economic Development Homebuyer Down Payment Grant Program

Community Planning and Economic Development Homebuyer Down Payment Grant Program Community Planning and Economic Development Homebuyer Down Payment Grant Program This application is for use in determining eligibility for Down Payment Assistance Program. You must have been pre-approved

More information

THE FLATS - Phase I 525 North Union Street, Wilmington, DE TTY 711 Fax:

THE FLATS - Phase I 525 North Union Street, Wilmington, DE TTY 711 Fax: THE FLATS - Phase I 525 North Union Street, Wilmington, DE 19805 302-656-0801 TTY 711 Fax: 302-656-0800 Thank you for your interest in The Flats - Phase I. This general occupancy apartment community is

More information

Public Housing Application Verification List: Please Read Thoroughly

Public Housing Application Verification List: Please Read Thoroughly Public Housing Application Verification List: Please Read Thoroughly In order to process your application we must make copies of the following items in the original document form (please do not bring copies):

More information

PERMANENT SUPPORTIVE HOUSING PRE-QUALIFICATION FORM

PERMANENT SUPPORTIVE HOUSING PRE-QUALIFICATION FORM PERMANENT SUPPORTIVE HOUSING PRE-QUALIFICATION FORM Cell number: Email address: Where are you currently living (if in shelter or details of location on the street): Applicant agrees to update or confirm

More information

GAINESVILLE HOUSING AUTHORITY APPLICATION/CONTINUED OCCUPANCY FORM

GAINESVILLE HOUSING AUTHORITY APPLICATION/CONTINUED OCCUPANCY FORM GAINESVILLE HOUSING AUTHORITY APPLICATION/CONTINUED OCCUPANCY FORM PART A: HOUSEHOLD COMPOSITION AND CHARACTERISTICS Personal Declaration This form must be completed in your own handwriting. You must use

More information

Please complete the enclosed KCHA packet with black or blue pen only and provide verification as applicable. INCOME

Please complete the enclosed KCHA packet with black or blue pen only and provide verification as applicable. INCOME SECTION 8 OFFICE 700 ANDOVER PARK W, SUITE A, TUKWILA, WA, 98188-3322 PHONE: (206) 214-1300 FAX: (206) 243-5927 Please complete the enclosed KCHA packet with black or blue pen only and provide verification

More information

NAHASDA EMERGENCY ASSSISTANCE APPLICATION ELIGIBILITY and CHECKLIST FORM

NAHASDA EMERGENCY ASSSISTANCE APPLICATION ELIGIBILITY and CHECKLIST FORM Page 1 of 6 Shawnee Tribe Housing Department P.O Box 189 Miami, OK 74355 Phone: 918-542-2441 Fax: 918-542-2922 ELIGIBILITY and CHECKLIST FORM THE FOLLOWING INFORMATION IS REQUIRED IN ORDER TO DETERMINE

More information

Managed by: Allenton Management, 3500 Westgate Dr., Suite #901, Durham, NC Residential Rental Application Supplemental Information

Managed by: Allenton Management, 3500 Westgate Dr., Suite #901, Durham, NC Residential Rental Application Supplemental Information COLE MILL PLACE APARTMENTS 1904 Cole Mill Road #201 Durham, North Carolina 27712 (919) 886-4130 (919) 493-1506 (FAX) www.housingfornewhope.org www.facebook.com/housingfornewhope Managed by: Allenton Management,

More information

Welcome to Pine Grove Apartments. Thank you for your interest in our community.

Welcome to Pine Grove Apartments. Thank you for your interest in our community. PINE GROVE APARTMENTS 600 Carlton Rd., #111 Palmetto, Georgia 30268 Tel 770-463-2107 Fax 770-463-5952 TDD # 800-255-0135 Visit our website: apartmentspalmetto.com TO ALL PROSPECTIVE RESIDENTS: Welcome

More information

Name: Address: Telephone number: Social Security Number: Relationship to HOH

Name: Address: Telephone number: Social Security Number: Relationship to HOH Family Information Name: Address: Telephone number: Social Security Number: Primary language: Yes No Family Composition (circle all appropriate categories from the choices below)* Name (last, first) Date

More information

RENTAL HOUSING APPLICATION

RENTAL HOUSING APPLICATION SAMPLE RH-3 RENTAL HOUSING APPLICATION This is a preliminary application for apartment at. It holds no lease or rent obligations. All information will be verified by the management prior to an applicant

More information

Applicant Criteria. Pheasant Ridge

Applicant Criteria. Pheasant Ridge Applicant Criteria Pheasant Ridge supports the Fair Housing Act as amended, and prohibits discrimination based on race, color, religion, sex, national origin, handicap or familial status. Section 8 applicants

More information

TENANT ELIGIBILITY/APPLICATION/SELECTION PLAN Complexes for disabled persons under age 62

TENANT ELIGIBILITY/APPLICATION/SELECTION PLAN Complexes for disabled persons under age 62 TENANT ELIGIBILITY/APPLICATION/SELECTION PLAN Complexes for disabled persons under age 62 Kiemle Hagood does not discriminate on the basis of race, color, creed, religion, sex, familial status, national

More information

City of Coachella First Time Home Buyer Program

City of Coachella First Time Home Buyer Program City of Coachella First Time Home Buyer Program The City of Coachella s (City) First-time Homebuyer Down Payment Assistance Program provides deferred-payment, low-interest loans to assist low income families

More information

The Grand Forks Housing Authority An Equal Housing Opportunity Provider

The Grand Forks Housing Authority An Equal Housing Opportunity Provider The Grand Forks Housing Authority An Equal Housing Opportunity Provider **IMPORTANT INFORMATION** READ & KEEP THIS PAGE To be eligible to receive housing assistance, the applicant must meet the following

More information

PLEASANT VIEW APARTMENTS 202 Larry Lane Pauls Valley, OK

PLEASANT VIEW APARTMENTS 202 Larry Lane Pauls Valley, OK Application for Rental Housing PLEASANT VIEW APARTMENTS 202 Larry Lane Pauls Valley, OK 73075 405-207-9474 Office Use Only of Application Time of Application Size Unit Desired Agent: Complete this application

More information

WE WILL NOT REVIEW INCOMPLETE APPLICATIONS.

WE WILL NOT REVIEW INCOMPLETE APPLICATIONS. Application Screening Policies and Fees Active Property Services represents the owners of this property. We are an equal housing opportunity property service and offer applications to anyone who requests

More information

1) To be eligible for this property, you must be at least 55 years of age to qualify. Income limits do apply.

1) To be eligible for this property, you must be at least 55 years of age to qualify. Income limits do apply. INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR THE INN AT CITY HALL: Thank you for your interest. The following instructions, if followed properly, will ensure timely processing of your application and

More information

POTTERVILLE HOUSING COMMISSION APPLICATION FOR HOUSING SERVICES

POTTERVILLE HOUSING COMMISSION APPLICATION FOR HOUSING SERVICES POTTERVILLE HOUSING COMMISSION APPLICATION FOR HOUSING SERVICES 210 E. Main St Potterville MI 48876 517-645-7076 fax: 517-645-7330 APPLICANT INFORMATION - PLEASE PRINT IN BLUE or BLACK INK Nam e (First,

More information

Subcontractor Agreement

Subcontractor Agreement Subcontractor Agreement This agreement is made by ABLED, a Nebraska Subchapter S Corporation, hereinafter referred to as ABLED and, hereinafter referred to as Subcontractor. WHEREAS, ABLED is certified

More information

RENTAL APPLICATION. PLEASE PRINT Bedroom Size: Application Date: Time: A.M. / P.M.

RENTAL APPLICATION. PLEASE PRINT Bedroom Size: Application Date: Time: A.M. / P.M. RENTAL APPLICATION If there are not enough extremely Iow-income families on the waiting list, we will conduct outreach on a non-discriminatory basis to attract extremely Iow-income families to reach the

More information

HOMELESS PREVENTION/INTERVENTION PROGRAM Information Sheet

HOMELESS PREVENTION/INTERVENTION PROGRAM Information Sheet HOMELESS PREVENTION/INTERVENTION PROGRAM Information Sheet The Homeless Prevention/Intervention Program is designed to prevent the incidence of homelessness. This program is intended to help with Short-term

More information

YWCA UTAH KATHLEEN ROBISON HUNTSMAN TRANSITIONAL HOUSING PROGRAM

YWCA UTAH KATHLEEN ROBISON HUNTSMAN TRANSITIONAL HOUSING PROGRAM YWCA UTAH KATHLEEN ROBISON HUNTSMAN TRANSITIONAL HOUSING PROGRAM 1. Fill out application completely with requested documentation. Incomplete applications cannot be processed. 2. Have referring worker complete

More information

THE FUCCI COMPANY 6 Regency Manor, Suite 1, Rutland, VT Tel Fax

THE FUCCI COMPANY 6 Regency Manor, Suite 1, Rutland, VT Tel Fax THE FUCCI COMPANY 6 Regency Manor, Suite 1, Rutland, VT 05701 Tel. 802-773-9107 Fax 802-773-0518 PLEASE PRINT ALL INFORMATION CLEARLY : PROJECT APPLYING FOR: BEDROOM SIZE: ANY SPECIAL ACCOMODATIONS NEEDED?:

More information

CITY OF DENISON -AN EQUAL OPPORTUNITY EMPLOYER-

CITY OF DENISON -AN EQUAL OPPORTUNITY EMPLOYER- CITY OF DENISON -AN EQUAL OPPORTUNITY EMPLOYER- Last Name First Name Middle Name Address: street city state zip code Phone Number: Email address: Position applied for: Date to start: Are you currently

More information

RESIDENT SELECTION PLAN

RESIDENT SELECTION PLAN CHINATOWN MANOR 175 N. HOTEL ST., HONOLULU, HI 96817 EAH Housing, BRE #853495, RB-16985 TELEPHONE (808) 545-1996 FAX (808) 536-6808 TDD (866) 835-8169 cm-management@eahhousing.org RESIDENT SELECTION PLAN

More information

Exterior Accessibility Grant Program

Exterior Accessibility Grant Program City of Davenport Community Planning and Economic Development Exterior Accessibility Grant Program This application is for use in determining eligibility for the City of Davenport s Exterior Accessibility

More information

WEST HILLS VILLAGE APARTMENTS 3100 Lake Brook Boulevard Knoxville, TN PH: (865) FX: (865) SELECTION CRITERIA

WEST HILLS VILLAGE APARTMENTS 3100 Lake Brook Boulevard Knoxville, TN PH: (865) FX: (865) SELECTION CRITERIA WEST HILLS VILLAGE APARTMENTS 3100 Lake Brook Boulevard Knoxville, TN 37909 PH: (865) 584-0229 FX: (865) 588-2950 SELECTION CRITERIA We want to thank you for considering West Hills Village as your next

More information

Requirements for Neighborhood Stabilization Program (NSP) Low-Income Housing 2015

Requirements for Neighborhood Stabilization Program (NSP) Low-Income Housing 2015 Name of Applicant Date Received 4515 Babcock St Palm Bay Fl. 32935 Mail: PO Box 1253, Melbourne, FL 32902-1253 321-474-0966 Fax: 206-984-2176 Requirements for Neighborhood Stabilization Program (NSP) Low-Income

More information

Please COMPLETELY read the information below about our waitlist processes, procedures, and rules:

Please COMPLETELY read the information below about our waitlist processes, procedures, and rules: Please COMPLETELY read the information below about our waitlist processes, procedures, and rules: Applying for housing: Our vacancies (or soon to be vacant units) can be found on our website at regionalhousingauthority.org.

More information

Hyde Park Apartments 336 W. 36 th Street Kansas City, Missouri Office: Fax:

Hyde Park Apartments 336 W. 36 th Street Kansas City, Missouri Office: Fax: Dear Applicant: Hyde Park Apartments 336 W. 36 th Street Kansas City, Missouri 64111 Office: 816-756-2710 Fax: 816-531-5813 Email: hydepark@dalmarkgroup.com Thank you for your interest in our community.

More information

Housing Eligibility Questionnaire

Housing Eligibility Questionnaire Office Use Only Time/ Received: Housing Eligibility Questionnaire INSTRUCTIONS: This information will be used to determine for which Avesta Housing communities your household is eligible. Please answer

More information