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32 Bronson St. Catskill, Greene County, New York 12414
(518) 943-2900
[email protected]
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HOME
About CHA
Departments & Staff
Board
Board Meeting Minutes
Board Meeting Minutes 2022
Board Meeting Minutes 2023
Board Meeting Minutes 2024
BOARD MEETING MINUTES 2025
History & Mission
Hop-O-Nose Site Map
By-Laws
HOP-O-Nose Resident Association
Careers
Doing Business With CHA
NEWS
HOUSING
Public Housing & Units
Housing Application
FOR OUR RESIDENTS
Pay Rent
How To’s
Emergency Maintenance
Maintenance & Service
Resident Forms
Complaint Form
Event Space
MEETINGS/EVENTS
RESOURCES & SERVICES
Community Services
Resident Resources
FAQ’s
GALLERY
CONTACT US
ROSS APPLICATION
Catskill - New York State - Public Housing
ROSS Aplication
Name
First
Last
Apartment/Unit Number
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
Phone
Birth Date
MM slash DD slash YYYY
Application Date
MM slash DD slash YYYY
Are you a citizen of the United States?*
Yes
No
Have you ever received case management services?*
Yes
No
If no, are you authorized to work in the U.S.?
Yes
No
If yes, when?
Have you ever been convicted of a felony? (Optional)
Yes
No
If yes, when?
EDUCATION: High School Name
EDUCATION: High School Address
Date Attended From
MM slash DD slash YYYY
Date Attended To
MM slash DD slash YYYY
Did you graduate?
Yes
No
EDUCATION: Diploma
EDUCATION: College Name
College Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Date Attended College From
MM slash DD slash YYYY
Date Attended College To
MM slash DD slash YYYY
Did you graduate?
Yes
No
Degree
EMERGENCY CONTACT: Name
First
Last
Relationship of Emergency Contact
EMERGENCY CONTACT
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
EMPLOYMENT: Company Name
EMPLOYMENT: Company Phone
EMPLOYMENT: Supervisor
EMPLOYMENT: Job Title
Starting Salary
Ending Salary
Responsibilities
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for leaving
DISCLAIMER & SIGNATURE: I certify that my answers are true and complete to the best of my knowledge.By completing this application, I understand that I am agreeing to receive case management services to ensure that I receive information about local services, courses, and trainings to gainfully pursue self-sufficiency. I understand that all information provided to the R.O.S.S Service Coordinator is confidential, unless I have signed a release form or have mentioned hurting myself or others.
SIGNATURE
DATE
