Public Housing Pre-Application

Application for Assistance
Check All That Apply
Sex:
Marital Status:
I Consider Myself:
Current Address:
Current Address:
Street
Apt/Suite/Trlr #
City
State/Province
Zip/Postal
Mailing Address:
Mailing Address:
Street
Apt/Suite/Trlr #
City
State/Province
Zip/Postal
(999)999-9999

Income Sources

$
Do you or any household member who will be living with you have the following sources of income?

Screening Process

Are any household members a U.S. Veteran?
Are any household members disabled or handicapped?
Have any household members been convicted of a crime?
Is any household member subject to a state sex offender registration program in any state?
Have any household members been evicted from a rental unit, moved while still owning rent and/or requested to repay money to a federal assisted housing program?
Are you currently receiving housing assistance?
Have any household members ever been a tenant of any housing authority or any other federal housing program?

Family Composition

Sex

Point System

Do you live in Santa Cruz County
Are you currently working more than 20 hours per week?
Is the head of household, co-head or spouse 62 years or older or with disabilities?
Is the head of household, co-head or spouse a veteran?
Are you a victim of domestic violence?
Are you being forced to move by a government action, private action or natural disaster?
Are you homeless?
If you answered yes to any questions above, please provide supporting document during the application intake

Documents

The following documents are required for all family members (if applicable)

  1. ID (Driver's license or state ID for 18 years or older
  2. Social Security Card
  3. Original Birth Certificate
  4. Permanent Resident Card, Passport or Naturalization Certificate
  5. Proof of Income
  6. Proof of Current Address(current utility bill or lease agreement under your name, state issued ID or official documents)

Maximum file size: 8.39MB

PDF, JPG, JPEG, PNG
I CERTIFY THAT ALL STATEMENTS ON MY PRE-APPLICATION ARE TRUE AND ACCURATE
IMPORTANT: THE APPLICATION DATE WILL REFLECT THE DATE RECEIVED. ONCE YOU ARE ON THE WAITING LIST, YOUR FILE WILL BE DROPPED IF YOU FAIL TO REPORT CHANGES IN ADDRESS, INCOME, HOUSEHOLD COMPOSITION. IF YOU FAIL TO RESPOND TO ANY CORRESPONDENCE, UPDATE OR APPOINTMENT ETC., YOU MUST REAPPLY.

NOTE: PUBLIC HOUSING APPLICANTS ARE SUBJECT TO CRIMINAL, RENTAL, AND CREDIT RECORD CHECKS DURING THE SCREENING PROCEES.

NHA Staff

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Contact Us

520-287-6571

Address

777 N. Grand Ave
Nogales, AZ, 85621

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