(832) 481-6670
1933 Hussion Street, Houston TX 77003
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Preliminary Application (Tax Credit / HOME)
Step
1
of
6
- About You
16%
About You - Head of Household
Full Name
*
exactly as shown on driver's license or ID card
Email Address
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Work Phone Number
Home Phone Number
Cell Phone Number
Birth Date
*
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Sex
*
Male
Female
Birth Place
Are you a US Citizen?
*
Yes
No
Visa #
*
Spoken Language
Race
Black
Hispanic
White
American Indian
Asian
Marital Status
Married
Single
Divorced
Separated
Widowed
Is the Head or spouse in the military service?
Yes
No
Name of Military Member
Military Branch
Does Anyone in Your Household Have Special Needs?
Yes
No
Residence History
Current Rent
Landlord / Apartment Name
Length of Residency in Unit
Have you ever lived in Public Housing or subsidized housing?
Yes
No
Name of Housing Location
Date Vacated
MM slash DD slash YYYY
Reason for Vacating
Have you ever participated in Section 8 of Existing Program?
Yes
No
Dates of Occupancy
Have you or any member of your household been evicted from subsidized housing or Public Housing or convicted of engaging in drug related criminal activity or other criminal activity?
Yes
No
Have you or any members of your household been convicted of a felony?
Yes
No
Do you reside in the City of Houston?
Yes
No
Are all members of the household full time students?
Yes
No
Your Household's Income
Income Source #1
Amount
Paid
Every Week
Bi-weekly
Monthly
Annually
Income Source #2
Amount
Paid
Every Week
Bi-weekly
Monthly
Annually
Income Source #3
Amount
Paid
Every Week
Bi-weekly
Monthly
Annually
Income Source #4
Amount
Paid
Every Week
Bi-weekly
Monthly
Annually
Income Source #5
Amount
Paid
Every Week
Bi-weekly
Monthly
Annually
List Other Occupants
Please list all persons who will live in the unit including adults, children, foster children, live-in aides (if needed for the care of a family member). Each box must be completed for each household member. You must use the correct legal name for each member of your household as it appears on their Social Security card. No one except those listed on this form may live in the unit.
Relationship (to Head of Household)
Full Name
Birth Date
Month
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12
Day
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1920
Sex
Male
Female
Relationship (to Head of Household)
Full Name
Birth Date
Month
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1920
Sex
Male
Female
Relationship (to Head of Household)
Full Name
Birth Date
Month
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1933
1932
1931
1930
1929
1928
1927
1926
1925
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1923
1922
1921
1920
Sex
Male
Female
Relationship (to Head of Household)
Full Name
Birth Date
Month
1
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1933
1932
1931
1930
1929
1928
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1926
1925
1924
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1922
1921
1920
Sex
Male
Female
Relationship (to Head of Household)
Full Name
Birth Date
Month
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1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Sex
Male
Female
Relationship (to Head of Household)
Full Name
Birth Date
Month
1
2
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5
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10
11
12
Day
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Sex
Male
Female
Emergency Contact Information
Emergency Contact Name
Emergency Contact Phone
Emergency Contact's Relation to You
Submit the Preliminary Application
You declare that all your statements on this Preliminary Application are true and complete. You authorize us to verify same through any means. If you fail to answer any question or give false information, we may reject your submitted preliminary application for our waiting list.
*
***Warning 18 U.S.C. 1001 provides, among other things, that whoever knowingly make or uses a document or writing containing any false, fictitious, or fraudulent statement or enter, in any matter the jurisdiction of any department or agency of the United States, shall be fined no more than $10,000.00 or imprisoned for no more than five (5) years or both.
I Acknowledge the information I have provided on this form is accurate and complete.
We MUST have a current and complete address on file for you at all times.
*
You must notify the housing authority, in writing, if your address or phone number changes after you have submitted this preliminary application to get on our wait list. If we try to contact you and the letter is returned by the Post Office, your name will be removed from the waiting list –
no exceptions
.
I Understand
This is a preliminary application form which does not automatically make me eligible for housing, it only places me on the wait list.
*
I Understand
Name
This field is for validation purposes and should be left unchanged.
Villas at Eastwood is the perfect place for you to call home. Don't waste time- contact us today!
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