Waiting List Status - Form
Download a blank fillable Waiting List Status - Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Waiting List Status - Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1W
L
S
F
AITING
IST
TATUS
ORM
Check here if you are reporting new information
Check here for Waiting List Status
This form can be used by families who would like to update their information
2931 M
S
. S
C
, CA 95060-5709
ISSION
T
ANTA
RUZ
(including address) or verify their status in any Waiting List for any program
: (831) 454-9455
F
: (831) 469-3712
PHONE
AX
administered by the Housing Authority of the County of Santa Cruz, including the
Section 8 Housing Choice Voucher Program (HCV) for the County of Santa Cruz and the Cities of Hollister and San Juan Bautista,
as well as the Low Income Public Housing program.
When the Housing Authority receives your completed form, a letter will be sent to you confirming that we have received the
information you have provided, as well as verifying that your name is on the Waiting List. Please be aware that you must keep the
Housing Authority informed, in writing, of any address change so we can contact you when it is your turn for a final eligibility
determination. If letters to you are returned to the Housing Authority as undeliverable, no further attempts will be made to contact
you and your name will be removed from its place in the Waiting List
W
L
:
Santa Cruz Section 8 HCV Program
AITING
IST
Low Income Public Housing
Hollister / San Juan Bautista Section 8 HCV Program
Other: ________________________________________________________________________
I hereby request that a verification of my placement date or change of address on the Waiting List shall be sent to the address
provided below.
P
.
LEASE PRINT THE INFORMATION REQUESTED BELOW
1. First Name: _______________________
2. Middle Initial: ___
3. Last Name: _________________________
4. Social Security Number: _________ - _______ - _________
5. Home Telephone: ( ______ ) ________ - __________
6. Other Telephone: ( ______ ) ________ - __________
7. Current Mailing Address: _________________________________________________________________
____________________________________________________________
Are you currently homeless?
No
Yes (Please note that a mailing address must still be provided.)
8. Name at the time I placed my name on the list: ________________________________________________________
9. Date or approximate date I placed my name on the list: Month: ______________________
Year: _____________
10. Number of adults in the household (18 and older)
Males: ________
Females: ________
11. Number of children in the household (under 18)
Males: ________
Females: ________
OPTIONAL
12. Are you or your spouse age 62 or older?
No
Yes
13. Do you or your spouse wish to claim disability status?
No
Yes
14. To help assess special housing needs, please indicate any special features you would require to accommodate a family
member with disabilities.
Wheelchair accessibility
Unit Adapted for the Hearing Impaired
Grab Bars
Ground Floor
Unit Adapted for the Visually Impaired
Other
15. Are you, or any member of your household, a current military serviceperson or a veteran who has been separated
under honorable conditions from any branch of the United States armed forces or the surviving spouse of a veteran?
No
Yes
Print Name: ____________________________
Signature: ________________________________
(Head of Household)
Print Form
050158
091814 JP
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business