To submit this form, complete the online application at the provided link. Do not attempt to submit via mail, fax, or email. Ensure that your application is submitted before the deadline to ensure you are considered for the lottery selection.

The waitlist will open on May 2, 2022, and close on May 16, 2022. Ensure you submit your online application within this period to be eligible for the lottery selection.

The purpose of this form is to allow applicants to request placement on the Housing Choice Voucher program waitlist. This assistance is intended for families and individuals with low income who need help with rental costs. By filling out this form, applicants indicate their interest and begin the process of receiving housing assistance.

• 1. Name: The full name of the applicant.
• 2. Address: The current residence address.
• 3. Income: The gross annual income of the household.
• 4. Household Size: The number of individuals living in the household.
• 5. Contact Information: Email and phone number for correspondence.

If you fail to submit this form, you will be ineligible for the Housing Choice Voucher program waitlist. This means you will not have a chance to be selected in the lottery for assistance. Timely submission is critical to ensure you are considered for the program.

• Missing the deadline: Failing to submit your application by 5:00 p.m. on the closing date will disqualify you.
• Incomplete application: Providing incomplete information may lead to rejection.
• No confirmation received: If you don't receive an acknowledgment of your application, you must reapply.

• 1. Applying for housing assistance: Use this form to express your interest in receiving housing vouchers.
• 2. Financial need assessment: Indicate your household income to assess eligibility.
• 3. Lottery inclusion: Submit the form to be entered into the selection lottery.