Preliminary Application For Public Housing
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1
2OFFICE USE ONLY
DATE OF RECEIPT
Brookline Housing Authority
Type: _________________________
Applications Department
Unit Size: ______________________
Office Hours: weekdays 8:30 – 4:30
Priority: _______________________
90 Longwood Ave. Ste. 1, Brookline, MA 02446
Preference: ____________________
Phone: 617-277-1885 Fax: 617-277-1462 TTD: 800-545-1833, x 213
Applicant ID: ___________________
Web: E-mail:
Preliminary Application for Public Housing
No documentation is required at this time.
1.
Applicant: First
Middle
Last
2.
Current Physical Address:
Apt. #
City
State
Zip
3.
Mailing Address
Apt. #
(if different):
City
State
Zip
4.
Contact Information: Phone
Cell
E-Mail
5.
Type of Housing: Select the type of housing for which you are applying. You may select more than one.
Elderly/Disabled
Family
Wheelchair Accessible
6.
Bedroom Size: List the desired bedroom size
Final determination of bedroom size will be made by our staff according to our policy which is based on your family composition.
7.
Family Composition: List all the people who will live in your household, beginning with yourself.
Last Name
First Name
Sex
Social Security #
Relationship
Date of Birth
Head-of-Household
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Parent category: Business