929-5588 APPLICATION FOR SECTION 8 ... - City of Norwalk
929-5588 APPLICATION FOR SECTION 8 ... - City of Norwalk
929-5588 APPLICATION FOR SECTION 8 ... - City of Norwalk
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NORWALK HOUSING AUTHORITY12035 Firestone Bl.<strong>Norwalk</strong>, CA 90650(562) <strong>929</strong>-<strong>5588</strong>For Office Use Only:Date Received:Preference Code: ________Date Entered: _______________Print first letter <strong>of</strong> last name<strong>APPLICATION</strong> <strong>FOR</strong> <strong>SECTION</strong> 8 RENTAL ASSISTANCEApplicant Name: _____________________________________________Telephone No._________________Address <strong>of</strong> Current Residence: __________________________________________ Apt. No.______________<strong>City</strong>, State, Zip Code: ______________________________________________________________________Mailing Address (If different): __________________________________________ Apt. No. _____________<strong>City</strong>, State, Zip Code: ______________________________________________________________________Family Composition: List all persons who will be living in assisted unit (include yourself).NameRelationto self SexDate <strong>of</strong>BirthDisabled?Y/NSoc. Sec. No.1. SELF2.3.4.5.6.7.8.General Information:1. Is your current residence located in the <strong>City</strong> <strong>of</strong> <strong>Norwalk</strong>? Yes No(If yes, attach a copy <strong>of</strong> your lease, utility bill or children’s school registration as pro<strong>of</strong> <strong>of</strong> residency)2. Are you displaced from a <strong>Norwalk</strong> residence as a result <strong>of</strong> government action or natural disaster?(If yes, attach copy <strong>of</strong> displacement notice) Yes No3. Is any member <strong>of</strong> the household a U.S. Veteran? Yes NoIf yes, who is a veteran? ____________________ (Attach copy <strong>of</strong> discharge papers. Form # DD214)4. Is any member <strong>of</strong> the household a spouse or minor child <strong>of</strong> a deceased U.S. Veteran? Yes No5. Are you attending college either full-time or part-time? Yes No(PLEASE TURN OVER)
Race <strong>of</strong> head <strong>of</strong> household: White Black/African American American Indian/Alaskan Native(check one) Asian Native Hawaiian/Other Pacific IslanderEthnicity (check one): Hispanic Non-HispanicLanguage <strong>of</strong> head <strong>of</strong> household:I Understand English: Well Not Well Not at all The language that I understand is: ______________I Speak English: Well Not Well Not at all The language that I speak is: _______________I Read English: Well Not Well Not at all The language that I read is: _______________I Write English: Well Not Well Not at all The language that I write is: _______________Sources <strong>of</strong> income: Write in amount <strong>of</strong> total monthly gross income in each category. Be sure to include allsources <strong>of</strong> income for your household.Social Security $_____________SSI (Supplemental Social Security) $_____________Retirement benefits/Pension $_____________Employment/Wages $_____________Welfare $_____________Veterans benefits $______________Disability/Workers compensation $______________Child Support/Alimony $______________Unemployment $______________Other______________________ $______________Employment Information: If any household members are employed, list employer’s name and full address:Name <strong>of</strong> household member Name <strong>of</strong> employer Work location street address and cityI certify under penalty <strong>of</strong> perjury that all information that I have provided is accurate and complete. I understand thatmaking false statements or providing false information is punishable under federal and/or state law.Signature <strong>of</strong> Head <strong>of</strong> Household ________________________________________ Date________________Signature <strong>of</strong> Spouse or Co-Head ________________________________________ Date________________RETURN COMPLETED <strong>APPLICATION</strong> BY MAIL ONLY TO:NORWALK HOUSING AUTHORITYATTN: <strong>APPLICATION</strong> DESK12035 FIRESTONE BOULEVARDNORWALK, CA 90650<strong>APPLICATION</strong> MUST BE POSTMARKED BETWEENMAY 7 - 25, 2007OR IT WILL NOT BE ACCEPTED.DON’T <strong>FOR</strong>GET TO ATTACH PROOF OF VETERAN STATUS AND/OR NORWALK RESIDENCY. YOU WILLNOT RECEIVE A PREFERENCE IF THE IN<strong>FOR</strong>MATION IS NOT SUBMITTED.THIS <strong>APPLICATION</strong> WILL ONLY BE ACCEPTED IF RECEIVED BY MAIL.IF YOU WOULD LIKE A RECEIPT,INCLUDE A SELF-ADDRESSED STAMPED ENVELOPE WITH YOUR <strong>APPLICATION</strong>.IT IS IMPORTANT THAT YOU NOTIFY THE NORWALK HOUSING AUTHORITY IN WRITING IF THERE IS A CHANGE TOYOUR MAILING ADDRESS. IF WE ARE UNABLE TO CONTACT YOU BY MAIL AT ANY TIME, YOUR <strong>APPLICATION</strong>WILL BE REMOVED FROM THE WAITING LIST.