Augusta Housing Authority
Waiting List Pre-Application
2/6/2012 8:29:59 AM
You must complete and receive confirmation for your application to be accepted online.  If you have any questions or have problems, please contact an application specialist at (706) 312-3121.


ASSISTED HOUSING PROGRAMS
WAITING LIST APPLICATION
HOUSING PROGRAM TYPE:
 Senior/Elderly Only

2 BDRM Units Only
0 & 1 BDRM Units Only

 Age 55 and over
 Age 55 and over
*PBV = Project Based Voucher
FULL NAME:
(First and Last) 		SEX: RACE:
SS #: BIRTH DATE:
MARITAL STATUS:    IS HOH:
ADDRESS:  
APT/SUITE:
CITY:   STATE:   ZIP:
PHONE #('S):
FAMILY COMPOSITION
NAME OF FAMILY MEMBER MALE OR FEMALE DATE OF BIRTH RELATIONSHIP
(1)  
(2)
(3)
(4)
(5)
(6)
(7)
(8)

TOTAL HOUSEHOLD INCOME
(List all money earned and/or received by everyone living in your household.  This includes money from wages (employment), self-employment, unemployment, TANF, child support, SS, SSI, Disability payments, retirement benefits, VA benefits, alimony, Workman's Comp., and all other sources.)
NAME OF FAMILY MEMBER SOURCE OR TYPE OF INCOME HOW OFTEN RECEIVED
(Weekly, Monthly, Etc)		 AMOUNT RECEIVED
(Please do not
add the $)
$
$
$
$
$
$
$

PREFERENCE SELECTION
HOMELESSNESS OR LIVING IN SUBSTANDARD HOUSING
RENT BURDEN (Paying more than 50% of your monthly income towards rent & utilities)
INVOLUNTARY DISPLACED
EMPLOYED (Head or spouse currently employed full-time (30+ hours per week) for a continuous period of six months)
ELDERLY/DISABLED (Head or spouse elderly (62+) or handicapped or disabled and receiving Social Security, Supplemental Security Income benefits or other disability benifits as a result of their inability to work.)
ARE YOU CURRENTLY LIVING IN PUBLIC HOUSING?
ARE YOU CURRENTLY HOUSED UNDER ANY SECTION 8 PROGRAMS?