Section 8 & Public Housing "*" indicates required fields 12 Head of HouseholdName First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork/Other PhoneAbout Your HouseholdRaceSelect all that apply White Black/African Hispanic American Indian or Alaskan Asian Hawaiian or Other Pacific Other Principal LanguageSelect BelowEnglishSpanishOtherHousehold MembersList all persons who will be living in vour household.Head of HouseholdPlease click the button below to Add Details about the Head of Household Legal Name Gross Monthly Income Actions Edit Delete There are no Head of Household Details. Add Head of Household Details Maximum number of head of household details reached. Household MemberPlease click the button below to Add Details about each additional household member Legal Name Gross Monthly Income Actions Edit Delete There are no Household Members. Add Household Member Maximum number of household members reached. Household MembersTotal Household Annual IncomeIncome Information(These questions apply to all household members)Has anyone in your household applied for any benefits or money which is in the process of being approved? Yes No Does anyone outside of your household pay for any of your bills or expenses? Yes No Does anyone in your household receive an educational scholarship or grant? Yes No Are you entitled to any of these?Please select all that apply Child Support Alimony Maintenance Do you receive Child Support? Yes No Do you receive Alimony? Yes No Do you receive Maintenance? Yes No Monthly Expenses(From last month) Row ID Expense Type Amount Actions Edit Delete There are no Expenses. Add Expense Maximum number of expenses reached. Do you pay childcare expenses? Yes No Please add each child below Name Amount Per (Weekly, Monthly, etc.) Actions Edit Delete There are no Children. Add Child Maximum number of children reached. Do you pay expenses for handicapped assistance? Yes No Handicapped Assistance Expenses Name Monthly Amount Actions Edit Delete There are no Family Members. Add Family Member Maximum number of family members reached. Do you have unusual Medical expenses?(elderly families ony) Yes No Monthly Medical ExpensesMedicareOther Health InsuranceRegular payments on medical billsRegular payments for medicineAnticipated healthcare related expenses in the next 12 monthsDocumentsUpload Files Row ID Document Type Notes File Actions Edit Delete There are no Files. Add File Maximum number of files reached. Property and AssetsHave you or anyone in your household ever owned a home or property? Yes No AssetsList all assets of all "Household Members (real estate,boats, mobile homes, etc.) Asset Cash Value Actions Edit Delete There are no Assets. Add Asset Maximum number of assets reached. Vehicles Owner Make Model Year Actions Edit Delete There are no Vehicles. Add Vehicle Maximum number of vehicles reached. Total Number of VehiclesLOCAL PREFERENCE CLAIM FORMFor Public Housing and Section 8 Applicants READ CAREFULLY AND CHECK ONLY THE PREFERENCES THAT APPLY TO YOU. VETERAN'S PREFERENCEThe head of household and/or spouse is currently a member of the Armed Forces, or the head of the household and/or spouse has an honorable discharge from the Armed Forces. In the case of a divorce or legal separation, the head of the household or former spouse must provide the Waco Housing Authority with documentation that the head or spouse has rights to benefits; there is no right to the veteran's preference. VETERAN'S PREFERENCEEMPLOYMENT PREFERENCEFamilies whose head of household or spouse is employed. Families whose head of household or spouse has been given a bona fide offer of employment. This preference does not require a minimum of income, but the family's annual income cannot exceed current very low income guidelines by HUD. Must have a minimum of 20 working hours a week for Section 8 and 24 hours a week for Public Housing. No minimum length of time is required for the head or spouse to be employed. After move-in the employment must continue for twelve (12) months or longer. EMPLOYMENT PREFERENCEELDERLYHead of Household or Spouse is 62 years of age or older. ELDERLYDISABLED AND HANDICAPPED HEAD OF HOUSEHOLDThis preference only applies to the Head of Household. DISABLED AND HANDICAPPED HEAD OF HOUSEHOLDJOB TRAINING/ SCHOOL PREFERENCEThe head of household or spouse is currently enrolled and participating in a job-training program that prepares them for entering or re-entering the job market. Families where the head of household or spouse is a graduate of a job-training program that prepared them for entering or re-entering the job market. Head of Household is currently enrolled in educational programs working toward a degree. Must be a full-time student (twelve hours or more) or give verifiable justification for carrying a lesser number of hours. JOB TRAINING/ SCHOOL PREFERENCEDOMESTIC VIOLENCE PREFERENCEHousehold annual income cannot exceed current income guidelines by HUD. Must be certified by the Family Abuse Center that provides shelter or counseling to victims of domestic violence. The Housing Authority shall determine that the domestic violence occurred recently (within 1 year) or is of a continuing nature. The applicant shall certify that the person who engaged in such violence will not reside with the family unless Housing Authority has advance written approval. The Housing Authority may deny or terminate assistance to the family for breach of certification. DOMESTIC VIOLENCE PREFERENCEFOR PUBLIC HOUSING RESIDENTS ONLYFor families living in Public Housing who wish to move into the private sector and receive rental assistance through the Section-8 Program, and participate in the home ownership program. Families must meet the following guidelines: Families must have resided in public housing a minimum of one year, and participate in the Family Self-Sufficiency Program. The family must participate in a job training program or attend an institution of higher learning or must maintain an earned income for a minimum of one year. Families must be crime and drug free. This includes all persons on the lease. Families must have a record of timely rent payments, for a twelve (12) month period. No balances left from month to month. Rent must be paid on or before the 5th of each month. All school-age children must be attending school regularly. School verification with authorized signature. Families must have established a pattern of keeping their apartment and premises clean both inside and outside with no graffiti. This includes roof, yard, stairways and porches. Must be in good standing with Public Housing at time of transfer. Development managers must certify that the families have met the requirements. TARGET UP AND OUTApplicant Social Security Number SignatureI understand that my application is not a determination of eligibility for assisted housing/ public housing. I will not immediately be offered housing, but will be placed on a Waiting List with other applicants, who may claim and/or are entitled to LOCAL PREFERENCE. The eventual extension of housing benefits will be based upon my place on the waiting list.Legal Consent*Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. Paper Copies You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies. Withdrawal of Consent You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically. I agree to the terms and conditions.NameThis field is for validation purposes and should be left unchanged.
