Superior Housing Authority Pre-Application

Superior Housing Authority Pre- Application

Please select the Property you are applying for (you can chose more than one):
Pre-Application

Online Pre-Application
Properties with an (*) require all household members to be 55 years of age or older: *

Cottages I & II Decker Dwellings Grand Central Plaza* New York Apartments* Rosewood I & II Washington Apartments*
Please note that our waiting list is currently closed for one-bedroom apartments and single person households because current applications on our waiting list significantly exceed what is available.
Full Name *

First Name Last Name
E-mail *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *
Birth Date *

Month Day Year
Gender *
Are you a full-time student (Includes K-12th grade and higher education)? *

Yes No
Including yourself, how many adults (any one 18 years and older) will live with you? *

1 2 3 4
How many minors (anyone 17 years and younger) will live with you? *

0 1 2 3 4 5 6
Total Household Members
Based on the information provided above
Will the household include anyone 17 years of age or younger?

Yes No
How many household members are 17 years of age or younger?
Are there additional household members 18 years of age or older?

Yes No

Please complete the following for Additional Applicants
Applicant #2 *

First Name Last Name
Applicant #2 Phone Number
Applicant #2 Birth Date

Month Day Year
Applicant #2 Gender
Is Applicant #2 a full-time student (Includes K-12th grade and higher education)? *

Yes No
Applicant #3 *

First Name Last Name
Applicant #3 Phone Number
Applicant #3 Birth Date

Month Day Year
Applicant #3 Gender
Is Applicant #3 a full-time student (Includes K-12th grade and higher education)? *

Yes No
Applicant #4 *

First Name Last Name
Co-Applicant 3 Phone Number
Applicant #4 Birth Date

Month Day Year
Applicant #4 Gender
Is Applicant #4 a full-time student (Includes K-12th grade and higher education)? *

Yes No

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Annual Income Information

Enter all income for household members 18 years of age or older. Enter each source of income separately by household member in the sections below. Skip any sections not needed.
Name *
Enter the household member who receives this income.
1st Source of income *

Employment Social Security Business Income Child Support Public Assistance Retirement Benefits Unemployment VA Benefits

Income 1 *

	Amount	Weekly	Monthly	Annually	Total
Income 1

2nd Source of Income. (Skip if no additional income.)
Name
Enter the household member who receives this income.
2nd Source of income

Employment Social Security Business Income Child Support Public Assistance Retirement Benefits Unemployment VA Benefits

Income 2

	Amount	Weekly	Monthly	Annually	Total
Income 2

3rd Source of Income. (Skip if no additional income.)
Name
Enter the household member who receives this income.
3rd Source of income

Employment Social Security Business Income Child Support Public Assistance Retirement Benefits Unemployment VA Benefits

Income 3

	Amount	Weekly	Monthly	Annually	Total
Income 3

4th Source of Income. (Skip if no additional income.)
Name
Enter the household member who receives this income.
4th Source of income

Employment Social Security Business Income Child Support Public Assistance Retirement Benefits Unemployment VA Benefits

Income 4

	Amount	Weekly	Monthly	Annually	Total
Income 4

Superior Housing Authority Pre- Application