Section 8 Housing Choice Voucher Program Centralized Waiting List Pre-Application printable pdf download

SECTION 8 HOUSING CHOICE VOUCHER PROGRAM

For Agency Use Only:

Date/Time

CENTRALIZED WAITING LIST PRE-APPLICATION

1. HEAD OF HOUSEHOLD

Social Security or Alien Registration #: __________________________ Date of Birth: ______________

First Name: ________________________ Middle: _____________ Last Name: __________________________________________

Home Address*: ____________________________________________________________________________________________

City/Town: ________________________________________________ State: ________ Zip Code: __________________________

Telephone: ___________________ E-mail: ___________________________Work Address* (City/Town ONLY): _____________

*Some housing authorities give preference to applicants and/or spouses living or working in the housing authority’s town.

Mailing Address (if different from Home Address): ________________________________________________________________

City/Town: ________________________________________________ State: ________ Zip Code: __________________________

2. SPOUSE/PARTNER

Social Security or Alien Registration Number: _____________________________ Date of Birth: ___________________________

First Name: ________________________ Middle: _____________ Last Name: __________________________________________

Work Address* (City/Town ONLY): ____________________________________________________________________________

3. HOW MANY PEOPLE WILL LIVE IN THE UNIT? Please include yourself. ______________________________________

4. TOTAL GROSS ANNUAL HOUSEHOLD INCOME: __________________________________________________________

5. IS HEAD OF HOUSEHOLD (Check ALL that apply):

White

 Black/African American

 American Indian/Alaska Native

 Native Hawaiian/Other Pacific Islander

Asian

6. IS HEAD OF HOUSEHOLD (Check only one):

 Hispanic

Non-Hispanic

Data on race & ethnicity is collected in accordance with federal regulations. Your answers will not affect your application.

7. PREFERENCES (Check ALL that apply.)

Please read attached “Definitions of Preferences” to determine which apply to you. NOTE: Participating housing authorities may

or may not use some or all of the preferences listed below. (A housing authority will request documentation of preferences at the time

you reach the top of the waiting list and are selected for final determination.)



1. Board of Health Condemnation

12. Homeless

2. Disabled

13. Rent Burdened 50% of Income

3. Displaced by Hate Crimes, Reprisals

14. Rent Burdened 40% of Income

4. Displaced by Landlord Non-Renewal

15. One-person Family

5. Displaced by Natural Disaster

16. Substandard Housing (includes homeless)

6. Displaced by Public Action

17. Client for Project Based Section 8 Unit

7. Displaced by Domestic Violence

18. Tenant of Project Based Section 8 Unit

8. Elderly

19. Veteran

9. Near Elderly (55+)

20. Working

10. Extremely Low Income

23. Participant in Metco Program in Wayland school

11. Health Condition (disability affecting housing need)

24. Activated Military Personnel to Persian Gulf

8. I CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE AND COMPLETE.

I understand that submission of false information or misrepresentation may result in loss of eligibility to participate in the

Section 8 Housing Choice Voucher Program. I certify that I have attained the age of eighteen and therefore have full legal

capacity to act on my own behalf in the matter of contracts.

Signature of Head of Household __________________________________________ Date ______________________

Complete ALL information. Return completed application to ONE of the participating housing authorities listed on the back

of this form. Incomplete, photocopied, e-mailed, or faxed applications will not be accepted.

Apply Online at

preapp 2/16

Section 8 Housing Choice Voucher Program Centralized Waiting List Pre-Application

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