NC Public Housing Application - Charlotte free printable template

Date Stamp CHA OFFICIAL USE ONLY Housing Authority of City of Charlotte ONLINE APPLICATION SITE APPLYING FOR Status Approve Bedroom Size Intake Processor s Signature Denied Prospect Program Type PUBLIC HOUSING APPLICATION Please do not use a pencil. Please use a black or blue ink pen. You must be 18 years old in order to submit an application. This application must be filled out completely. Failure to do so will place your application in the incomplete file and it will not be placed on the...Waiting List. First Name Last Name Street Address City State Zip Code Telephone Number Home Social Security Birth Date Race White Black/African American American Indian/Alaska Native Asian Native Hawaiian/Pacific Islander Other Wage VA Ethnicity Hispanic Non-Hispanic Type of Monthly Income check all that apply SS TANF SSI Child Support Retirement/Pension Unemployment Sex/Gender Male Female Bank Account Family Type Family Disabled check all that apply Hearing impaired Sight impaired Mobility...impaired Elderly 62 and older Near Elderly 50 61 Amount of Monthly Income Number Of Adults Highest Education Completed Elementary High School Jr. College College/University Post Graduate Savings Of Children in Family girl s boy s Assets Stocks Bonds Money Market account Do you own any pets Yes No Please specify Drivers License Occupation Are you a US citizen Yes Citizen No Noncitizen How did you hear about us check all that apply None Sign Drive By Walk-in Referral Word of Mouth...Yellow pages Newspaper Applicant Signature Have you ever lived in federally subsidized housing Date Yes No If yes please give the name of the Housing Authority and address. If you answered yes to 1 please answer 2 Did you leave owing the Housing Authority any money Have you as head of household ever been convicted of a felony for drug-related criminal activity or violent criminal activity within the last seven 7 years Has anyone in your household ever been arrested or convicted of a felony for...drug-related criminal activity or violent criminal offense occur in Example SC NC etc* ever committed any fraud in Federal assistance housing program or been requested to repay money for knowingly misrepresenting information for such housing programs or have you been requested to repay any monies I do hereby certify that the information I gave is true and accurate to the best of my knowledge. Please list the individuals that will be living with you. These persons must be related to you by blood...marriage or adoption* Only list the individuals that will actually be living with you. Name of Members Relationship Head of Household Is any member expecting a baby Age - - - - - - - - - - - - Which member Sex - Due date. Failure to do so will place your application in the incomplete file and it will not be placed on the Waiting List. First Name Last Name Street Address City State Zip Code Telephone Number Home Social Security Birth Date Race White Black/African American American Indian/Alaska...Native Asian Native Hawaiian/Pacific Islander Other Wage VA Ethnicity Hispanic Non-Hispanic Type of Monthly Income check all that apply SS TANF SSI Child Support Retirement/Pension Unemployment Sex/Gender Male Female Bank Account Family Type Family Disabled check all that apply Hearing impaired Sight impaired Mobility impaired Elderly 62 and older Near Elderly 50 61 Amount of Monthly Income Number Of Adults Highest Education Completed Elementary High School Jr.