Warren Metropolitan Housing Authority, OH - Form: Waiting List Change Form

This form must be completed and returned if any changes occur while your name is on the waiting list. Changes may affect your placement on the waiting list.

Name(*)

SSN#(*)

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Phone(*)

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Email Address:

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Address(*)

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City(*)

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State(*)

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Zip Code(*)

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Is this an address change?(*)

YesNo Invalid Input

Which waiting list are you currently on?(*)

HCV (Section 8)Public HousingBoth Invalid Input

List ALL person's that will be living in the household:

Name(*)

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Relationship(*)

Invalid Input

Date of Birth(*)

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Sex(*)

FemaleMale Invalid Input

Social Security #(*)

Invalid Input

Race(*)

Invalid Input

Hispanic(*)

YesNo Invalid Input

Name-2nd

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Relationship

Invalid Input

Date of Birth

Invalid Input

Sex

FemaleMale Invalid Input

Social Security #

Invalid Input

Race

Invalid Input

Hispanic

YesNo Invalid Input

Name-3rd

Invalid Input

Relationship

Invalid Input

Date of Birth

Invalid Input

Sex

FemaleMale Invalid Input

Social Security #

Invalid Input

Race

Invalid Input

Hispanic

YesNo Invalid Input

Name-4th

Invalid Input

Relationship

Invalid Input

Date of Birth

Invalid Input

Sex

FemaleMale Invalid Input

Social Security #

Invalid Input

Race

Invalid Input

Hispanic

YesNo Invalid Input

Name-5th

Invalid Input

Relationship

Invalid Input

Date of Birth

Invalid Input

Sex

FemaleMale Invalid Input

Social Security #

Invalid Input

Race

Invalid Input

Hispanic

YesNo Invalid Input

Name-6th

Invalid Input

Relationship

Invalid Input

Date of Birth

Invalid Input

Sex

FemaleMale Invalid Input

Social Security #

Invalid Input

Race

Invalid Input

Hispanic

YesNo Invalid Input

Preferences that CURRENTLY apply to you:

Are you or your spouse currently a member of the U.S. Armed Forces, an honorable discharged veteran or widow of such?(*)

YesNo Invalid Input

Do you live or work in Warren County?(*)

YesNo Invalid Input

Have you ever been assisted by the WMHA Transitions program or any transitional housing program?(*)

YesNo Invalid Input

When?

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Completed?

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Are you or your spouse been employed at least 6 months, with less than 2 weeks between employment?(*)

YesNo Invalid Input

Are you 62 or older?(*)

YesNo Invalid Input

Are you disabled AND receiving compensation for the disability?(*)

YesNo Invalid Input

Are you a household with a non-elderly person with disabilities transitioning out of institutional or other segregated settings, at serious risk of institutionalization, homeless, or at risk of becoming homeless?(*)

YesNo Invalid Input

Acknowledgement(*)

I agree that the below signature will be the electronic representation of my signature for all purposes-just the same as a pen and paper signature. Invalid Input

Type Name for Signature(*)

Invalid Input

Waiting List Change Form

Warren Metropolitan Housing Authority

Waiting List Change Form

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