Home Applicants WFHA Pre-Application Form
FOR STATISTICAL PURPOSES ONLY
Q01: Are you currently displaced due to a disaster-fire, flood, hurricane, earthquake, or governmental action such as Modernization or property disposition (housing is inaccessible or uninhabitable)? Yes | NoQ02: Are you currently residing in a shelter from being a victim of domestic violence? Yes | NoQ03: Is the Head of household or Co-Head/Spouse Elderly (62 years or older)? Yes | NoQ04: Is the Head of household or Co-Head/Spouse Disabled? Yes | NoQ05: If you answered yes to either question above, do you wish to reside at an Elderly/Mix property Yes | NoQ06: Do you or anyone in the household need a wheelchair accessible apartment? Yes | NoQ07: Is any family member's mobility, hearing or visually impaired? Yes | NoQ08: Is the Head of household 51-61 years of age and if so do you wish to reside at on Elderly/Mix property?Yes | No*Elderly/Mix Property-All residents must be 62 years of age or older or be a disabled individual of any age.Q09: Have you ever violated a previous obligation in connection with a HUD Program? Yes | NoQ10: Do you owe any low income Housing programs (PHA, Section 8 or other Program)? Yes | No
B. Please check the bedroom size you require:1 BEDROOM | 2 BEDROOM | 3 BEDROOM | 4 BEDROOM
I/ certify that the statements on this application are true to the best of my/our knowledge and belief and understand that they will be verified and understand that any false statements made on this application will be cause for me/us to be disqualified for admission. I/we authorize the release of information to the Housing Authority by the Social Security Administration. and/or other business or government agencies.
Head of Household Signature Date
Co-applicant Signature Date
WAITING LIST POLICYI understand that I am on the active Waiting List for a _ bedroom apartment. In order to stay on the active Waiting List, I must visit or contact the Housing Authority office immediately to report any changes in family size, income, address, telephone, etc.
Applicant Signature Date
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