Regional HCV in-place Application

The Stanislaus Regional Housing Authority is an equal opportunity housing provider. Stanislaus Regional 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.

Si necesita ayuda para completar el proceso de solicitud, llame al 209-557-2000.
Housing Choice Voucher Application

In-Place Residents of Alpine, Amador, Calaveras, Inyo, Mariposa, Inyo and Tuolumne Counties
Applications are limited to residents of Alpine, Amador, Calaveras, Inyo, Mariposa, Mono and Tuolumne counties who qualify for the following preference:

Applicant families who meet the definition of family/elderly/or disabled who are:

• Not residing in a rental unit which receives Federally subsidy (tenant rent portion set at 30% of net monthly income); and

• Currently residing in a rental unit in which the family qualifies to participate in the Housing Choice Voucher Program; and

• The landlord is willing to enter into a Housing Assistance Payments Contract

OR:
- Graduate of a Permanent Supportive Housing Program administered by a Local Continuum of Care Agency
Note: Failure to provide true and complete information regarding residence may result in denial of waitlist placement.
Please select county of residence: to qualify for the preference, you must live or work in one of the following counties*

AlpineAmadorCalaverasInyoMariposaMonoTuolumne
Is the applicant a graduate of a Permanent Supportive Housing Program administered by a Local Continuum of Care Agency?*

NoYes
Please attach a notice from the administering agency to certify the status of "graduating from a Permanent Supportive Housing Program"*

Browse Files

Cancelof
Do you live in a unit where your rent is “based or set” at 30% of your monthly income?(Examples: Project-based Section 8, Rural Development, Public Housing/Conventional Housing, or other subsidized housing)*

NoYes
Housing Circumstances: select your current housing circumstance*

Renting from a Landlord or Property Management, paying full rentShared Housing/Renting a roomMobile Home (own home, paying space rent)Permanent Supportive Housing ProgramOther
Do you currently reside in a unit where the owner/landlord will accept Housing Choice Voucher? (Section 8)*

YesNo
Will the owner/landlord rent to you under the Housing Choice Voucher Program? (Section 8)*

YesNo
Landlord, Owner, or Property Manager*
Name of landlord, owner, or property manager
Landlord, Owner, or Property Manager's Phone Number*

Area CodePhone Number
Landlord, Owner, or Property Manager's email
example@example.com
Household Information

Complete the following information about the applicant's household.
First Name*
Last Name*
Does Head of Household have a Social Security Number?*

YesNo
Social Security Number*
Date of Birth*

MonthDayYear
Is there a Co-Head of Household?*

YesNo
First Name (Co-Head)*
Last Name*
Does Co-Head of Household have a Social Security Number?*

YesNo
Social Security Number*
Date of Birth*

MonthDayYear
Physical Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Is there a different mailing address?

NoYes
Mailing Address (if different from physical address)*

Mailing address or P.O. Box

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Cell Phone or Message Number*

Area CodePhone Number
Email*
Enter email address to receive a confirmation of application
Head or Co-head is a US Veteran, current service person, or surviving spouse?:*

YesNo
Head or Co-head is 62 years of age or older; or is disabled?:*

YesNo
Family Size*
Including yourself, the number of persons who will live with you under the HCV program
Number of children (under 18) living in household*
(must have at least 51% custody to claim children in household)
Total Gross Monthly Income (before taxes or deductions)*
Include income for all members from all sources
Monthly Rent*
Source(s) of Income/Benefits: (check all that apply)*

Social Security (SSA)Supplemental Social Security (SSI)CalWorks (cash aid, TANF/AFDC, GA)Unemployment (UIB/EDD)Employment/WagesSelf-EmployedPension or RetirementVA Pension/BenefitsWorkman's Compensation/State Disability (SDI)Child Support/AlimonyOther
Is there a disabled person in the household who requires a Reasonable Accommodation in order to have access to the Housing Authority's programs?*

YesNo
If yes, please briefly describe the accommodation.
Did a service provider, or other individual, complete this application on behalf of the applicant?*

YesNo
What is the name and contact information of the person who completed the application*
Applicants are considered for housing without regard to age, race, color, familial status, religion, sex, disability, or national origin. To help the Housing Authority comply with Federal/State record keeping and other legal requirements, please check the appropriate box.
Race (check all that apply)*

WhiteBlack/African AmericanAsianNative American or Alaskan NativeNative Hawaiian or other Pacific IslanderDecline to answerOther
Ethnicity (choose one)*

HispanicNon-HispanicDecline to answer
VAWA (Violence Against Women Act)

Protections for Applicants
If you otherwise qualify for assistance under the Housing Choice Voucher 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.
Stanislaus Regional Housing Authority is an equal opportunity housing provider. Stanislaus Regional 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 for assistance.
DISCLAIMER: Submission of this application does not guarantee placement on a Waiting List, eligibility, or an offer of housing.
Signature of Head of Household: By signing below, I confirm that all information provided in this application is true and complete.

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MonthDayYear
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Housing Choice Voucher Application

Household Information