Housing Application - Catskill Housing Authority

Applicants Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you the head of house hold?

Name of Cohead

Phone

Email

Do you have any special needs?

Are you currently employed?

If yes, please explain by whom, address and phone number

List previous employment

How many people in your family will be living with you

List all the members in your house hold

Is your income above $40,000/year?

Are there any members in the house hold with income?

If yes, please explain how much

Has anyone in your household previously lived in the Catskill Housing Authority?

Where are you currently living?

Have you or any member of your household been convicted of any crime (misdemeanor or felony)?

Are you or a member of your household required to register as a lifetime sex offender in any state?

Have you or any member of your household ever been evicted from a Federal or publicly subsidized housing program?