Affordable Housing Waitlist (Page 2 of 3) in pdf

Affordable Housing Waitlist Page 2

INCOME

What is your approximate total yearly income (before-tax income from all jobs, self-employment, Social Security,

Pensions, payments from friends/family, unemployment, child support, alimony, income from assets etc)?

PREFERENCE INFORMATION

Are you, or any member of your household, in need of an accessible unit? This is defined as persons with a

physical or mental disability that meet standards established by the Department of Housing and Community

Development and state laws for disabled housing.

£ Yes

£ No

REASONABLE ACCOMODATION

Does any member of the household have any accessibility or reasonable accommodation requests or changes in a

unit or development or alternative ways we need to communicate with you?

£ Yes

£ No

If yes, please explain in the space provided here:

)

ACE

PTIONAL

You are requested to complete the following optional section in order to assist in determining preference.

Completing this section may qualify you for additional lottery pools. (Please check all boxes that apply):

£ Alaskan Native and Native American

£ Asian

£ Black or African American (not of Hispanic origin)

£ Native Hawaiian or Pacific Islander

£ Hispanic or Latino

£ White (not of Hispanic origin)

£Other (please specify)___

Affordable Housing Waitlist Page 2