Farm Labor Application

The Stanislaus Regional Housing Authority is an equal opportunity housing provider. Stanislaus Regional Housing Authority does not discriminate on the basis of disability status in its admission or access to housing programs. If you need assistance completing this form, or if you require assistance in another language, please call (209) 557-2000.
Farm Labor Housing Application

Off-Farm Labor Housing
Eligible Households are:

Households with earnings from Farm Labor employment of $5,753 or more annually

Households with retired Farm Labor family members (retirement can be due to age or disability)

Widow/Spouse of a deceased Farm Labor worker

At least one Farm Labor income earner or retired family member must have legal immigration status.
Please select one option: *

Application Application update
Household Information
Annual Farm Labor Income *
Retired/Disabled Farm Laborer or Spouse/Widow (those who retired directly from Farm Labor related work)?

Yes No
Based on your response, you are not eligible to apply at this time. (PLEASE REVIEW, AND UPDATE YOUR REPONSE IF NEEDED)

Eligible Households are:

Households with earnings from Farm Labor employment of $5,753 or more annually

Households with retired Farm Labor family members (retirement can be due to age or disability)

Widow/Spouse of a deceased Farm Labor worker

At least one Farm Labor income earner or retired family member must have legal immigration status.
Full Name *

First Name Last Name
Date of Birth *

Month Day Year
Social Security Number *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Do you have a mailing address different from your physical address? *

No Yes
Mailing Address *

Street address or P.O. Box

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
Cell Phone or Message Phone Number *

Area Code Phone Number
E-mail *
Is the Head of Household, or Co-head of Household, any of the following: *

US Veteran or surviving spouse of US Veteran 62 years of age or older Disabled None of the above
Number of adults in household (including Head of Household) *
Number of minor children in household *
Gross Annual Income *
All sources
Source(s) of income (select all that apply) *

Employment (Farm Labor) Employment (non-Farm Labor) CalWorks (cash aid) General Assistance Self-employment Unemployment (EDD/UIB) Social Security(SSA, SSDI) Supplemental Security Income (SSI) Pension/Retirement benefits Veterans Benefit or Pension
Select the city where you would accept housing: *

Modesto Ceres Patterson Westley
Are you presently living in public housing or have a section 8 voucher? *
Emergency Contact Information
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Race is requested for reporting to the U.S. Department of Housing and Urban development (HUD) and is used for statistical purposes only to ensure non-discrimination *
Ethnicity is requested for reporting to the U.S. Department of Housing and Urban development (HUD) and is used for statistical purposes only to ensure non-discrimination *
VAWA (Violence Against Women Act)

Protections for Applicants
If you otherwise qualify for assistance under the Rural Development Farm Labor Housing Program, you cannot be denied admission or denied assistance because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking.
For more information on VAWA, contact Stanislaus Regional Housing Authority at (209) 557-2000.
DISCLAIMER: Submission of this application does not guarantee placement on a waiting list, eligibility, or an offer of housing.
Should be Empty:

Farm Labor Housing Application

Household Information

Emergency Contact Information