Family Self‐Sufficiency (FSS) Program Pre‐Enrollment Form

Family Self‐Sufficiency (FSS) Program Pre‐Enrollment Form

The FSS Program is open only to persons currently living in LHAND public housing or who have a LHAND Housing Voucher. (This is not an application for LHAND housing.)
Thank you for your interest in LHAND's FSS Program! All sections of this form must be completed to process your application. You will be contacted by an FSS Coordinator when you are eligible to attend an FSS orientation session. Family Self-Sufficiency Program slots are limited, and completion of this form is not a guarantee by LHAND of your acceptance into the program.

Date*

MonthDay Year
Date
Please check one:*

I live in Curwin Circle (Public Housing)I have a LHAND Housing Choice Voucher (Section 8)
Is there anybody who is 18 years or older in your household who is not currently employed? (Note, if the answer is "yes," you will be directed to fill out a No Income Statement after submitting this form).*

YesNo
Case Representative
Name*

First Name Last Name
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Last 4 digits of SSN*
Home Phone*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Best time to call *
Email*
example@example.com
Age*
Gender*

MaleFemale
Total in household under age 18*
Total age 18 or older*