Application For Section 8 Rental Assistance (Page 2 of 5) in pdf

Application For Section 8 Rental Assistance Page 2

PULASKI COUNTY PUBLIC HOUSING AGENCY

APPLICATION FOR SECTION 8 RENTAL ASSISTANCE

Please complete the application carefully. Be sure to answer ALL questions.

County: ____________________

Date: _____________________

Time: ________________________

NAME: __________________________________________ (PREVIOUSLY USED NAMES) ____________________

MAILING ADDRESS _______________________________________________ APT # ________________________

CITY: ________________________________ STATE: ____________________ ZIP: ________________________

HOME PHONE: __________________________________ WORK: _______________________________________

OTHER ADULT/OR SPOUSE WORK #: ______________________________________________________________

LIST ALL PERSONS WHO WILL LIVE IN THE UNIT WHEN YOU BEGIN TO RECEIVE RENTAL ASSISTANCE PAYMENTS:

Member #1

Head of Household

Last Name: __________________________________ First Name: _______________________________

Middle Initial: ________ Sex: ___________ Date of Birth ______________ SS# ____________________

Birth City/State: ___________________ United States Citizen? (Circle One)

Yes or No

Disabled? *(Circle One) Yes or No

Race (Circle One)

White

Black

Asian

Mixed

American Indian

Hawaiian/Pacific Islander

(* Only a disability other than drug or alcohol addiction)

Education (Highest Grade Completed):__________

Ethnicity (Circle One) Hispanic or Latino Not Hispanic or Latino

Please Circle One:

Member #2

Spouse Co-Head of Household

Adult-Other

Full-Time 18+

Foster Child

Live-In Aide

Youth-Under 18