Preliminary Application For Housing Choice Voucher
ADVERTISEMENT
1
2PRELIMINARY APPLICATION FOR
PUBLIC HOUSING
Complete this application (please print) and return to CMHA. Each family member must be a current household member. All
adult members 18 years or older must sign this application to certify that the information about this is complete and correct.
Failure to complete this application as instructed may cause your application to be rejected.
PUBLIC HOUSING DEPT
Note: The acceptance of your application places you on the
APPLICATIONS OFFICE
wait list for the Public Housing program. This is
th
880 E. 11
AVENUE
not a promise of housing. All applicants are
COLUMBUS, OHIO 43211
subject to suitability and eligibility requirements.
(614) 421-6307
selection is based upon wait list position and unit
availability
ATTENTION: PLEASE USE FULL NAME AS IT APPEARS ON YOUR SOCIAL SECURITY CARD
Household Head (HOH):_____________________________
Spouse/Co-Tenant: _____________________________
Social Security No: ___________________________ ______
Social Security No: _____________________________
Date of Birth: ________________________________
Date of Birth: __________________________________
Present Address: __________________________________________________________________________________________
Address
City
State
Zip Code
Phone (Home):__________________________________
(Work):________________________________________
PLEASE ANSWER THE FOLLOWING QUESTIONS WITH YES OR NO:
1) _______ Have you (or your spouse) served (or are currently serving) in the U.S. Armed Forces? (Verification of military status will
be requested at a later date.)
2) _______ Is your rent currently subsidized by any other housing assistance program?
If applicable, how much are you currently paying for rent at your current address? $________ If none, please explain below:
3) _______ Will you require a handicapped accessible unit or accommodation?
Please provide the following information. Failure to complete the application may cause CMHA to determine you to be
ineligible for the Public Housing program. All information is subject to verification when you are requested to complete a final
application.
(Please see reverse side of this form)
Rev. 8/11
HOUSEHOLD COMPOSITION: Please list all members of your family, including yourself:
NAME
DATE OF
SOCIAL SECURITY
SEX
RELATION
RACE
BIRTH
NUMBER
TO HOH
CODE
1.________________________________/____/__________________-______-___________________________________________
2. ________________________________/____/__________________-______-___________________________________________
3. ________________________________/____/__________________-______-___________________________________________
1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business