Youngstown Metropolitan Housing Authority Housing Eligibility Application Form
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4Youngstown Metropolitan Housing Authority
131 West Boardman Street, Youngstown, OH 44503
(330) 744-2161
Housing Eligibility Application Form
List the Head of Household (Legal Name)
Sex
SSN
Date of Birth
Age
Last
First
MI
Race:
Ethnicity:
Do you require any modifications or accommodations
White
Hispanic
in order to fully utilize the unit or the program and
Black/African American
Non-Hispanic
its services?
Yes
No If yes, explain below:
American Indian/Alaska Native
Asian
Native Hawaiian/Other Pacific Islander
Which of the following housing programs are you applying for?
Public Housing
Section 8 (New
Construction – Lowellville Park Apartments)
Other Housing Program
Present Address Information
Street Address ___________________________________________________________________
Street
City
State
Zip
Mailing Address ___________________________________________________________________
Street
City
State
Zip
Home Tel. (
) _______________ Business Tel. (
) _______________ Landlord: _________________
List previous street address before moving to the address listed above.
Street Address ___________________________________________________________________
Street
City
State
Zip
List a contact person that we may contact if the Housing Authority is unable to reach you.
Name ______ _________________________________Tel. ____________________________
Address ____________________________________________ Relation __________________
Household members: List the legal names of all household members below. Start with the head of
household, then spouse or co-head, then minors (oldest to youngest) and then any other adults.
No.
Legal Name
Sex Relationship
SSN
Date of
Age
School
to Head
Birth
Name/Occupation
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