HousingAI

Tenant Application

Complete the form below to apply for housing assistance.

IndividualFamily

Applicant - Personal Identifiers

First Name

Last Name

Date of Birth

SSN (or Alternate ID)

Gender (Optional)

Marital Status (Optional)

Contact & Residency

Street Address

City

State

Zip

Phone

Homelessness Status (Optional)

Race & Ethnicity (Voluntary for HUD Reporting)

Ethnicity

Race

Providing race/ethnicity is voluntary and used for civil rights and reporting compliance.

Income & Assets

Employment Income (Monthly)

Benefits (SSI/SSDI/TANF) (Monthly)

Other Income

Assets: Checking/Savings

Assets: Retirement/Securities

Assets: Other

Current Housing Situation

Preferences & Priority Status

Veteran Status

Elderly/Disabled Household

Accessibility Needs/Reasonable Accommodation

Describe mobility, sensory or other accommodation needs.

VAWA Optional Disclosure

Domestic violence, dating violence, sexual assault or stalking (if applicable for protections/preferences).

Document Upload

Upload photos of government-issued photo IDs (adults), Social Security Cards, and citizenship/eligible immigration documents or signed declarations. Also upload photos as applicable to your case, the last 4 to 6 pay stubs, benefits awards letters, unemployment printouts, child support statements, pension/annuity statements and self-employment ledgers/tax returns. Also upload photos as applicable the last 3 months of statements for assets listed and any verification of interest/dividends.

Choose File

Certifications

I certify that I am a citizen/national or eligible non-citizen of the United States.

I consent to background screening as part of this application.

I consent to the release of information needed to verify my eligibility.

I certify that all statements made in this application are true and complete to the best of my knowledge.

Applicant Signature (type full name)

Date