ROSS Application


WFHA Programs

Ross Intake Application Form - PDF Format

WICHITA FALLS HOUSING AUTHORITY
ROSS Intake Form
Name:
 
Name of Head of Household (if you are NOT head of household):
 
Address:

zip code:  Unit: 
Phone Num:    Alternative Phone Num: 
Date of Birth:    Email Address: 

Employment/Income
Are you currently employed? (Check one)
No   Yes, PART TIME   Yes, FULL TIME (35+ hours)
Name of employer:

Job Title:
 
Date began employment:
 
Work schedule:
 
If you are not employed, what do you see as your major difficulty in finding employment?


Education/Training
How many years of school have you completed?
Years of College: 
Have you completed any certificate or trade programs? 
I have completed (Check one): GED High School Diploma I have not completed either.
Are you interested in obtaining a GED? Yes No N/A
Notes: 

Transportation
Do you have your own transportation? Yes No
Do you have car insurance? YES No N/A
Do you use public transportation? Yes No
Do you need bus passes? Yes No
Do you have a valid Driver’s License? Yes No
What state was your license issued?:  

ROSS PARTICIPANT NAME:

DATE: