PRE-APPLICATION
This is a pre-application.  The Housing Authority of Somerset will use the submitted information to establish a file on the applicant.  When additional information is needed, a representative of the Housing Authority of Somerset will contact the applicant.

TYPE OF ASSISTANCE NEEDED

HEAD OF HOUSEHOLD

HEAD OF HOUSEHOLD NAME:

SS#:

DATE OF BIRTH:

SEX

RACE:

 :

ETHNICITY:

PROVIDE THE FOLLOWING INFORMATION FOR ALL OTHER HOUSEHOLD MEMBERS.
NAME:

DATE OF BIRTH:
SEX:

SS#
NAME:

DATE OF BIRTH:
SEX:

SS#
NAME:

DATE OF BIRTH:
SEX:

SS#
NAME:

DATE OF BIRTH:
SEX:

SS#
PHYSICAL ADDRESS:

MAILING ADDRESS: (LEAVE BLANK IF SAME AS PHYSICAL ADDRESS)

ESTIMATED TOTAL FAMILY INCOME:

INCOME RATE:

INCOME SOURCE:

DISABLED?

IF SO IS THE DISABILITY PHYSICAL?

DOES THE FAMILY HAVE AN IMMEDIATE AND URGENT NEED FOR HOUSING? 

WHY DO YOU NEED ASSISTANCE?

HAVE YOU LIVED IN PUBLIC HOUSING BEFORE? 

PLEASE SUBMIT NAME, ADDRESS AND PHONE NUMBER OF CURRENT LANDLORD

PLEASE SUBMIT NAME, ADDRESS AND PHONE NUMBER OF LAST LANDLORD
ADDITIONAL COMMENTS: