Section 8 Full Application Form - Charleston Kanawha Housing
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2Section 8 Full-Application Form
*All blanks must be completed*
Household Composition
Social Sec #
Race
Name
Relationship
Birth Date
Age
Birthplace (city & state)
1.
Head of
Household
2.
3.
4.
5.
6.
7.
8.
Do you expect any changes in the current household composition (baby expected, getting married)?
If yes, please explain:
Regarding any children listed: Do you have ( )Full custody and they live with you full time,( )Shared custody and they live with you part time,
( )Only visitation? If needed please explain:
Mailing address:
City
State
Zip
Email address___________________________________________________________ Phone: ____________________________________
List two friends or relatives who could reach you in case of emergency:
Name:
Name:
Address:
Address:
Phone:
Phone:
Current Landlord: ___________________________________ Current Landlord Phone: __________________________________________
Previous Landlord:
Previous Landlord Phone:
Household Information (Regarding all household members)
How often are you paid?
Household Member
Source of Income
Weekly
Bi-Weekly
Bi-Monthly
Monthly
Monthly Gross Income
1.
2.
3.
4.
5.
1)
Do you expect any changes, within two to three months, in current household income?
If yes, please explain:
2)
Do you or have you owned, in the last two years: land, mobile home, or house?
If yes to any of the questions above, please explain:
3)
Do you have a bank account or any assets (checking, savings, stocks, bonds, CD, etc.)?
If yes, complete the following:
Bank:
Account Number:
Current Balance:
4)
Do you pay child care expenses because of employment or attending school?
If yes, complete the following:
Care Provider:
Mailing Address:
Phone:
Amount Paid Monthly:
5)
Is any household member(s), 18 years of age or older enrolled as a full-time student? _
If yes, please complete the following:
Family Member:
Educational Facility:
Mailing Address:
Expected Graduation Date:
Phone:
6)
Does anyone outside your household pay for any of your bills or give you money?_________________ If so, give name and address:
_____________________________________________________________________________________________________________
Give Reason: __________________________________________________________________________________________________
7)
Do you receive any of the following:
Food Stamps
$__________
Child Support Incentive Check
$___________
AFDC
$
TANF
$
School Grant or Scholarship
$__________
Work Study Program
$___________
LEAP
$__________
JTPA / WIA
$___________
Title IV of the Higher Education Act of 1965
$__________
Earned Income Tax Credit Refund
$___________
Title V of the Older Americans Act
$__________
Medical Card
[ ] Yes [ ] No
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Parent category: Business