Preliminary Application For Housing Assistance
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15301 W. Cypress Street Tampa, FL 33607
P
A
P
H
RELIMINARY
PPLICATION FOR
UBLIC
OUSING
This is a preliminary application. Once this pre-application is processed, we will notify you of your status. Qualified applicants will
be scheduled for a full application meeting before being placed on a waiting list. Disqualified applicants will receive a letter detailing
the reasons for denial. Please provide correct mailing address where Tampa Housing Authority may notify you of the status of this
pre-application. Please mail this application to Public Housing Central Intake, 5301 W. Cypress Street, Tampa, FL 33607.
one priority property
P
C
: When completing this pre-application process, you are required to select
that you are
ROPERTY
HOICE
interested in applying for. You will be given the opportunity to select more than one property at a later time. Note: Be sure the
property you select has the bedroom size needed for your family composition.
ONLY ONE PRE-APPLICATION PER
HOUSEHOLD PLEASE
PUBLIC HOUSING
ROBLES PARK VILLAGE
3814 CENTRAL AVENUE 33603
1-5 BEDROOMS
NORTH BLVD. HOMES
1129 MAIN ST. 33607
1-5 BEDROOMS
ELDERLY APARTMENTS: (55 years or older)
J.L. YOUNG APARTMENTS
8220 N. FLORIDA AVE. 33604
STUDIO-1 BEDROOMS
BETHUNE HI-RISE
1515 UNION ST.
33607
STUDIO-2 BEDROOMS
SOUTH SCATTERED SITES
ARBORS AT PADGETT ESTATES
4714 S. TRASK AVE. 33611
1-3 BEDROOMS
AZEELE APARTMENTS
2801 AZEELE 33609
1-2 BEDROOMS
BAY CEIA APARTMENTS
3422 MACDILL AVENUE 33629
1-2 BEDROOMS
SOHO APARTMENTS
212 S HOWARD AVENUE 33606
1-2 BEDROOMS
ST. LOUIS/ST. CONRAD
2310 ST. LOUIS 33607
3 BEDROOMS
NORTH SCATTERED SITES
SEMINOLE PARK
4706 MUSKOGEE CT. 33610
1-3 BEDROOMS
ND
SCRUGGS MANOR
11201 N 22
AVENUE 33612
2-3 BEDROOMS
AZZARELLI APARTMENTS
5038 TEMPLE HEIGHTS 33617
2-3 BEDROOMS
SHIMBERG ESTATES
1314 SLIGH AVENUE 33604
1-2 BEDROOMS
SQUIRE VILLA
5817 N. ROME AVENUE 33603
1 BEDROOMS
C. BLYTHE ANDREWS
2201 E. OSBORNE AVENUE 33610
3-5 BEDROOMS
F
C
AMILY
OMPOSITION
Last Name: _____________________________ First Name: ______________________MI___ DOB:________________
SS#: _________________________________ Sex: _________ Day/Work Phone: _______________________________
Mailing Address: _____________________________________________City, State, Zip:_________________________
List all other members of the household. Do not include yourself.
Last Name, First Name, MI
Relationship
Sex
Age
DOB
SS#
Total Monthly Household Income: $___________________
Total Household Members: __________
H
C
H
OUSING AND
RIMINAL
ISTORY
Have you ever lived in public housing, section 8 or any subsidized housing complex? YES
NO
If so, Where: ______________________ When: ________________Do you owe a balance? ________________
Have you ever been evicted or terminated from public housing, section 8 or any subsidized housing complex? YES NO
If so, Where: __________________________ When: ______________________Why: ____________________
Have you ever been arrested for any of the following criminal activities?
None of the following
Drug Related Activity
Date: _____________________
Violent Criminal Activity
Date: _____________________
Sexual Offenses
Date: _____________________
Other Felony
Date: _____________________
Warning: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make false statements or
misrepresentation to any department or agency of the U.S. as to any matter within its jurisdiction.
Consent: My signature is the consent which will allow the Tampa Housing Authority to acquire all family members’
criminal record and other necessary information in order to determine my eligibility for public housing.
Applicant Signature: _____________________________________________
Date: _________________________
Submit by mail or in person only. No Faxed or e-mailed applications accepted. Incomplete pre-applications will not be
processed.
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