Section I – HEAD OF HOUSEHOLD INFORMATION
First Name: Last Name:
Mailing Address, if different from above:
Home Phone: Cell Phone: Work Phone:
E-mail: Number of Bedrooms? One Two Three
Do you require a handicap accessible home? Yes No
Do you currently receive rental assistance? Yes No
Are you, your spouse and all your household compositions United States Citizen(s)? Yes No
If not explain status
How did you hear about this program?
Section II
I certify that the information submitted in this application is true and complete to the best of my knowledge and belief and that any misrepresentation of income or household size herein shall be cause for program disqualification. In submitting this application, I also authorize Triad Associates to request a credit report in order to review for mortgage qualification purposes only. I understand that this information is to be used only for determining my eligibility for referral to an affordable housing unit and does not obligate me in any way. Triad Associates shall not release any information gathered during this process to any third party without your consent.
I have read and agree with the terms above.
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