Project-Based Voucher Program - Pre-Application For Housing Assistance (Page 3 of 3) in pdf

Project-Based Voucher Program - Pre-Application For Housing Assistance Page 3

This housing list is updated periodically. For information on the availability of new apartments or on apartments in other parts of the

state call the number at the top of this form or visit the Housing Consumer Education Center website at

Certification of Applicant

Please read this statement very carefully. By signing, you are agreeing to its terms.

I hereby certify that the information I have provided in this pre-application is true and accurate. I understand that:

any misrepresentation or false information will result in my application being cancelled or denied, or in termination of housing



assistance;

this is a pre-application for project-based rental assistance through DHCD and its regional administering agencies and is not



an offer of housing;

at the time I rise to the top of the waiting lists, I will be required to provide verification of the information I have provided



here, in accordance with federal housing regulations and DHCD policy;

it is my responsibility to notify any one of DHCD’s regional administering agencies in writing of any change of address and my



application may be cancelled if I fail to do so;

it is my responsibility to notify any one of DHCD’s regional administering agencies in writing of any change in family size or



composition that might affect the number of bedrooms my family requires and my failure to do so may affect my place on the

waiting list;

my participation in the Section 8 housing program is subject to my being eligible and in compliance with HUD and DHCD



regulations; and that I will be subject to a criminal history check.

I agree that DHCD can share my information with other state agencies for the purposes of determining program eligibility.

Signature of head of household

Date

12/2//15(28)

Project-Based Voucher Program - Pre-Application For Housing Assistance Page 3