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*Applicants claiming preference will be required to verify preference eligibility at time of occupancy interview.
For HUD Statistical Purposes Only:
(If different than above)
Identify monthly amount of gross household income for ALL family members
Note: Additional information will be required for program participation once your name reaches the top of the waiting list. If you have a change of address or change in family composition you must report the change in writing to MHA Administrative Office.
Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false
statements to any department of the United States government.
If you have a change of address, income, or composition please report the change in writing to MHA Administrative Office. You will be contacted by MHA using your preferred contact method when you are approaching the top of the Public Housing waiting list.
I certify that the above information is accurate and complete. I understand that submission of false information or misrepresentation may
result in loss of eligibility for participation in the Public Housing Program.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Head of Household Signature Only
This field is not part of the form submission.
* indicates a required field