Project-Based Voucher Program - Pre-Application For Housing Assistance printable pdf download

Section 8

Please complete and return to:

Project-Based Voucher Program

Metropolitan Boston Housing

Partnership

125 Lincoln Street

Boston, MA 02111-2503

For agency use only:

Pre-Application for housing assistance

(617)859-0400

Date/Time Stamp/

Control Number

Please print neatly in ink. All fields are required. Submit this form only. Incomplete, photocopied, e-mailed or faxed applications will not be accepted.

If you are already on our tenant-based Section 8 waiting list your record will be updated using the information that you provide below. Due to the

volume of applications received, we will not verify the receipt of mailed applications. We cannot be responsible for material that is illegible or missing as

a result of transmitting by fax or e-mail or lost/delayed through the mail.

IMPORTANT!

One-third of all applicants are dropped from the waiting list due to unreported address changes. Do not let this happen

to you. Report any change of address in writing to the agency listed above.

Head of Household Information

Social Security Number

Phone (include area code)

First Name

Middle Name

Last Name

Address

City/Town

State

Zip code

Shelter Name

Shelter Address

City/Town

State

Zip code

Family Information

Write in the approximate amount of your family’s gross (before taxes) annual income. Include all sources for all

family members.

Gross annual household income $_____________

List the Head of Household and all other members who will be living in the unit. Give the relationship of each

family member to the head. For example: spouse/partner, son, daughter, aunt, grandmother, etc….

First Name

Last Name

Relation to Head

Birth Date

Age

Sex

Social Security

Number

Head of Household

If you have more than eight family members, please check here

and list them on a separate piece of paper.

For Agency Use Only. Number of Household Members

Household Bedroom Size:

Single

1BR

2BR

3BR

4BR

5BR

Check if the head of household or spouse is:

62 years old or older

Disabled

Check if anyone in the household requires a wheelchair accessible unit

We collect data on race & ethnicity in accordance with federal regulations. People of various races may also be of Hispanic

ethnicity. Please indicate if you are Hispanic. Your answers will not affect your application.

Race of head of household (You may choose more than one of the following)

White

Black/African American

American Indian/Alaskan Native

Asian

Native Hawaiian/Other Pacific Islander

Ethnicity of head of household (Check only one)

Hispanic

Non-Hispanic

What is your current housing situation? (Check only one box)

I am homeless

I live in substandard housing

I have been involuntarily displaced by fire, flood, or other natural disaster

I pay more than 50% of my monthly income for rent and utilities

I live in a shelter

I am doubled up with friends or relatives

I live in public housing

I live in a transitional housing program

I live in subsidized housing

Other (describe)

TURN PAGE OVER – APPLICATION CONTINUED ON REVERSE

12/2/15(28)

Project-Based Voucher Program - Pre-Application For Housing Assistance

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