waitingListPreApplication

Applicant Information

IP Address: 100.24.113.182

First Name: *

Last Name: *

Social Security Number: *

Applicant Information

Family Members

Reasonable Accommodation

		Needs Accommodation
	Explain:

Applicant Questions

If any of this information is incorrect or needs to be updated, please contact the housing authority.

Waiting Lists To Apply To

Applicant Information

Head of Household

	First Name:
	Middle Initial:
	Last name:
*Required	Birth Date: *	(mm / dd / yyyy)
*Required	Gender: *
		Has Disability
*Required	Primary Race: *
*Required		Hispanic Not Hispanic

Reasonable Accommodation

		Needs Accommodation
	Explain:

Annual Income

	Pension:
	SSI:
	Wages:
	Social Security:
	TANF:
	Unemployment:
	Child Support:
	Other non-Wage:

Additional Info

Current Residence Information

Move In Date:

(mm / dd / yyyy)

Rent / Own:

Rent Own

Rental Amount:

Address Line 1:

Address Line 2:

Apartment/Unit Number:

Zip Code:

City:

State:

Reason you are looking to move:

Current Landlord Information

Landlord Name:

Landlord Phone #:

( ) -

Landlord Address Line 1:

Landlord Address Line 2:

Apartment/Unit Number:

Zip Code:

City:

State:

References

Reference 1 Name:

Relation:

Phone #:

( ) -

Reference 2 Name:

Relation:

Phone #:

( ) -

Reference 3 Name:

Relation:

Phone #:

( ) -

Applicant Questions

Contact Information

Email:

Primary Phone:

( ) -

Secondary Phone:

( ) -

Primary Mailing Address

Address Line 1: *

Address Line 2:

Apartment/Unit Number:

Zip Code: *

City: *

State: *

Secondary Mailing Address

Address Line 1:

Address Line 2:

Apartment/Unit Number:

Zip Code:

City:

State:

Waiting List Preferences

Waiting Lists To Apply To

Agreement

IP Address: 100.24.113.182

The Marion Metropolitan Housing Authority requires all applicants to update their application every 6 months or immediately if you have a change in address. Thank you for applying to the Waiting List. You will be contacted via United States First Class Mail once you reach the top of the waiting list. Keep in mind it is your responsibility to keep the Housing Authority updated in writing should your mailing address change, this allows the housing authority to make contact with you.

The above information is correct and complete to the best of my knowledge.

Confirmation

Applicant Name:

Date / Time Applied: