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WACO HOUSING AUTHORITY & AFFILIATES

Housing Assistance Application

Do Not Write In This Area - WHA USE ONLY







	Bedroom Size	Application No.

This form must be completed in your own handwriting.

PLEASE PRINT AND USE BLUE OR BLACK INK.

NAME

(HEAD OF HOUSEHOLD)

MAILING ADDRESS

CITY, STATE, ZIP

HOME PHONE NUMBER

WORK or OTHER PHONE NUMBER

APPLYING FOR:

( X ) Public Housing (Kate Ross, South Terrace, Estella Maxey)

RACE: (check all that apply to you)
( ) White ( ) Black/African	(	)	Hispanic	( ) American Indian or	( ) Hawaiian or ( ) Asian ( ) Other
				Alaskan	Other Pacific

PRINCIPAL LANGUAGE:	(	)	English	( ) Spanish	( ) Other

HOUSEHOLD MEMBERS

List all persons who will be living in your household, beginning with head of household at #1.

	LEGAL NAME	Relationship	Social Security	Occupation or		City & State of
No	LEGAL NAME	to Head of	Social Security	Occupation or	Date of Birth	City & State of	Age	Sex
No	(Must use correct legal name)	to Head of	Number	School Name	Date of Birth	Birth	Age	Sex
	(Must use correct legal name)	Household	Number	School Name		Birth
		Household
1		HOH

2

3

4

5

6

7

8

INCOME

List all income of household members listed ABOVE (including benefits for children) (Salary, Tips, Social Security, SSI, TANF, Food Stamps, Pensions, Child Support, etc.)

ONE SOURCE OF INCOME PER LINE

FAMILY MEMBER

SOURCE OF INCOME

(Job, SS, SSI, TANF, Individual, child

support)

AMOUNT

HOW OFTEN

(weekly, monthly, bi-monthly, etc.)

INCOME INFORMATION

				(These questions apply to all household members)	YES	NO
Has anyone in your household applied for any benefits or money which is in the process of being approved?

Does anyone outside of your household pay for any of your bills or expenses?

Are you entitled to	(	) Child Support	(	) Alimony ( ) Maintenance?

Do you receive	(	) Child Support	(	) Alimony ( ) Maintenance?

Does anyone in your household receive an educational scholarship or grant?

MONTHLY EXPENSES

(From preceding month)

Rent	Telephone	Medical	Credit Card

Electric	Auto Payment	Cable	Credit Card

Gas	Auto Insurance	Insurance	Loan

Water	Child Care	Rentals	Other

CHILDCARE EXPENSES

Do you pay childcare expenses?	( ) Yes	( ) No

If yes, list each child’s name below			Amount	Per (Month, Weekly, etc.)

HANDICAPPED ASSISTANCE EXPENSES

FAMILY MEMBER(S)

Amount

Per

(Month, Weekly, etc.)

Reason

MEDICAL AND UNUSUAL EXPENSES

ELDERLY FAMILIES ONLY

	Amount	Per (Month, Weekly, etc.)
Medicare

Other health insurance

Regular payments on medical bills

Regular payments for medicine

Anticipated healthcare related expenses in the next 12 months

Have you or anyone in your household ever owned a home or property?

( ) Yes

( ) No

ASSETS

List all assets of all “Household Members listed on page 1. (real estate, boats, mobile homes, etc.)

ASSETS	CASH VALUE

VEHICLES

How many vehicles does the family own?_________

Owner	Make	Model	Year	Color	License #	State

HOUSING AUTHORITY OF THE CITY OF WACO, TEXAS

LOCAL PREFERENCE CLAIM FORM

For Public Housing and Section 8 Applicants

READ CAREFULLY AND CHECK ONLY THE PREFERENCES THAT APPLY TO YOU.

∙VETERAN’S PREFERENCE:

The 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.

∙EMPLOYMENT PREFERENCE:

Families 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.

∙ELDERLY:

Head of Household or Spouse is 62 years of age or older.

∙DISABLED AND HANDICAPPED HEAD OF HOUSEHOLD:

This preference only applies to the Head of Household.

∙JOB TRAINING / SCHOOL PREFERENCE:

The 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.

∙DOMESTIC VIOLENCE PREFERENCE:

Household 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.

FOR PUBLIC HOUSING RESIDENTS ONLY

TARGET UP AND OUT:

For 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:

1.Families must have resided in public housing a minimum of one year, and participate in the Family Self-Sufficiency Program.

2.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.

3.Families must be crime and drug free. This includes all persons on the lease.

4.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.

5.All school-age children must be attending school regularly. School verification with authorized signature.

6.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.

7.Must be in good standing with Public Housing at time of transfer.

8.Development managers must certify that the families have met the requirements.

I 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.

/	/
Social Security Number			Applicant Signature		Date

EMERGENCY CONTACT

NAME

ADDRESS

PHONE NUMBER(S)

RELATIONSHIP

	PERSONAL REFERENCES
	(relatives, close friends, employers, Pastor, neighbors, etc.)
NAME		PHONE NUMBER

ADDRESS		RELATIONSHIP


NAME		PHONE NUMBER

ADDRESS		RELATIONSHIP


NAME		PHONE NUMBER

ADDRESS		RELATIONSHIP

RESIDENCE HISTORY

(List where you have lived for at least the last three years beginning with where you live now)

(If you live with someone else that pays the rent or owns the property, list that person as your landlord)

CURRENT STREET ADDRESS	MOVE-IN DATE		CURRENT RENT

CURRENT LANDLORD NAME	CURRENT LANDLORD’S PHONE NUMBER


PREVIOUS ADDRESS	MOVE-IN DATE	MOVE-OUT DATE	RENT

LANDLORD NAME	LANDLORD’S PHONE	NUMBER


PREVIOUS ADDRESS	MOVE-IN DATE	MOVE-OUT DATE	RENT

LANDLORD NAME	LANDLORD’S PHONE	NUMBER

BANKING INFORMATION

List banking information for all “Household Members” listed on page 1. (checking, savings, credit union shares, annuities, stocks, bonds, CD’s, etc.)

Name of Financial Institution	Type of Account	Current Balance

	CREDIT HISTORY

CREDITOR		PHONE NUMBER

ADDRESS		CREDIT TYPE (loan, credit card, car payment, etc.)


CREDITOR		PHONE NUMBER

ADDRESS		CREDIT TYPE (loan, credit card, car payment, etc.)

INPUT CLERK:

DATE:

PROGRAM INTEGRITY INFORMATION

(These questions apply to all household members) (All questions must be answered)

HAVE YOU, YOUR SPOUSE, OR ANY HOUSEHOLD MEMBER LISTED ON YOUR APPLICATION:

YES

Been evicted or asked to move out of any rental property?
If yes, Who?	Where?	When?

Broken a rental agreement or lease contract?
If yes, Who?	Where?	When?

Been sued for nonpayment of rent?
If yes, Who?	Where?	When?

Been sued for damage to rental property?
If yes, Who?	Where?	When?

Been arrested for criminal activity?
If yes, Who?	Where?	When?

Been convicted of a crime?
If yes, Who?	Where?	When?

Been arrested and/or convicted for the use, sale, manufacture, or distribution of any controlled substance?
If yes, Who?	Where?	When?

Lived in Subsidized Housing (Public Housing, Section 8, etc.)?
If yes, Who?	Where?	When?

Been evicted from Public or Assisted housing for violent criminal or drug related activity?
If yes, Who?	Where?	When?

Used a name other than the one you are using now?
If yes, what name?

Used a social security number other than the one listed above?
If yes, what is it?


DO YOU, YOUR SPOUSE, OR ANY HOUSEHOLD MEMBERS LISTED ON YOUR APPLICATION:			YES	NO


Currently use a controlled substance or illegal drug?
If yes, explain

Owe money to a Public or Assisted Housing Agency?
If yes, Who?	What Agency?

Have any relatives (by blood or marriage) who are now an employee of Waco Housing Authority?

If yes, Who?

Are you or anyone listed on your application a registered sex offender?

Does anyone listed on page 1 as a “Household Member” claim mobility, visual or hearing impairment, or other special need which would require a special type of unit or other accommodation?

If yes, please describe:

Do you expect anyone to move in or out of your household within the next 12 months?

If yes, explain:

Does anyone live with you now that is not listed on page 1?

If yes, who?

Do you have any pets?

If yes, what kind?

Question	Answer
Form Name	WACO Housing Authority Application Form
Form Length	3 pages
Fillable?	Yes
Fillable fields	108
Avg. time to fill out	22 min 25 sec
Other names	wacopha, housing authority waco texas, housing waco tx, waco housing

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