waitingListPreApplication

Applicant Information

IP Address: 3.238.118.27

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: 3.238.118.27

I do hereby authorize the Housing Authority of the County of Morris to obtain a "consumer report" as defined in the Fair Credit Reporting Act, 15 U.S.C. Sec. 1681a(d), seeking information on the credit worthiness, credit standing, credit capacity, general reputation, or mode of living of applicants. I understand that any misrepresentation of information or failure to disclose information requested in this application may disqualify me from consideration for admission or participation, and may be grounds for eviction or termination of assistance. TITLE 18, SECTION 1001 OF THE UNITED STATES CODE, STATES THAT A PERSON WHO KNOWINGLY AND WILLINGLY MAKES FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OR AGENCY OF THE U.S. GOVERNMENT IS GUILTY OF A FELONY.

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

Confirmation

Applicant Name:

Date / Time Applied: