Oak Leaf Meadows PBV

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

Creekside Terrace
5118 Fournier Rd, Mariposa

Project-based Voucher Program
1, 2 and 3 bedroom units

Creekside Terrace is a 42-unit multifamily project in the community of Mariposa. The project is made up of 18 one-bedroom units, 13 two-bedroom units, and 11 three-bedroom units. On-site amenities include a playground, basketball court, and community center with computer lab and additional meeting space. Project funding includes low-income housing tax credits, project based vouchers and HCD’s No Place Like Home funding, so additional rental restrictions may apply.

Applicants will be asked to provide verification of any preference claimed.

Income Limits: Eligible households must have annual income below 50% of the area median income as defined by HUD. Income limits are published annually by HUD and can be found at https://www.huduser.gov/portal/datasets/il.html or at the Housing Authority's website www.stanregionalha.org

As of 4/18/22, the income limits for Mariposa County are:

Households will be assigned bedroom size based on the family's composition. The occupancy standards are as follows:

Bedroom	Household Minimum	Household Maximum
1 Bedroom	1	3
2 Bedroom	2	5
3 Bedroom	4	7

Household Information

Please complete the following questions regarding the applicant's household. All responses must contain true and complete information.

Does the household currently live or work in Mariposa, Ca? *

Yes No

First Name (Head of Household) *

Last Name *

Does Head of Household have a Social Security Number? *

Yes No

Date of Birth *

Is there a Co-Head of Household? *

Yes No

First Name (Co-Head) *

Last Name *

Does Co-Head of Household have a Social Security Number? *

Yes No

Date of Birth *

Physical Address *

Number and Street

Street Address Line 2

City State

Zip Code

Check here if mailing address is different than physical address.

Different mailing address

Mailing Address *

Mailing address or P.O. Box

Street Address Line 2

City State

Zip Code

Phone Number *

Area Code Phone Number

Cell Phone or Message Number *

Area Code Phone Number

Email *

Enter email address to receive a confirmation of application

Is Head or Co-head a US Veteran, current service person, or surviving spouse?: *

Yes No

Is Head or Co-head 62 years of age or older?: *

Yes No

Is Head or Co-head disabled? *

Yes No

Family Size *

Including yourself, the number of persons who will live with you under the Project-based program

Number of children (under 18) living in household *

(must have at least 51% custody to claim children in household)

Bedroom size requested (subject to approval):

Total Gross Annual Income (before taxes or deductions) *

Include income for all members and from all sources

Is the household comprised entirely of full-time students now, or within the last 5 months? *

Yes No

Does the household anticipate becoming an "all full-time student household" within the next 12 months? *

Yes No

If the household is comprised entirely of full-time students, please select any of the following that apply. Is any member of the household: *

Receiving CalWorks (TANF/AFDC) Enrolled in Job Training Program (through JTPA or similar program) Married and filing a joint tax return (or is entilted to) A single parent with child/children, neither of which are dependents of another person Foster Child (age 18 - 24 years old)

Source(s) of Income/Benefits: (check all that apply) *

Is there a person with disabilities in the household who requires a Reasonable Accommodation in order to have access to the Housing Authority's programs? *

Yes No

If yes, please briefly describe the accommodation. *

Did a service provider, or other individual, complete this application on behalf of the applicant? *

Yes No

What is the name and contact information of the person who completed the application *

Is the applicant household currently on the waiting list for Housing Choice Voucher Program (formerly Section 8)? *

Yes No

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) *

White Black/African American Asian Native American or Alaskan Native Native Hawaiian or other Pacific Islander Decline to answer

Ethnicity (choose one) *

Hispanic Non-Hispanic Decline to answer

VAWA (Violence Against Women Act)

Protections for Applicants
If you otherwise qualify for assistance under the Project-based 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.

DISCLAIMER: Submission of this application does not guarantee placement on a Waiting List, eligibility, or an offer of housing.

APPLICANT CERTIFICATION: BY SIGNING THIS FORM, I CERTIFY THAT THE INFORMATION GIVEN ON THIS FORM IS ACCURATE AND COMPLETE TO THE BEST OF MY/OUR KNOWLEDGE.

I UNDERSTAND THAT FALSE STATEMENTS OR INFORMATION ARE PUNISHABLE UNDER FEDERAL LAW, TITLE 18, SECTION 1001 OF THE UNITED STATES CODE.

I ALSO UNDERSTAND THAT FALSE STATEMENTS OR INACCURATE AND/OR OMITTED INFORMATION ARE GROUNDS FOR TERMINATION AND OR DENIAL OF HOUSING ASSISTANCE AND/OR TERMINATION OF TENANCY.

Head of Household Signature *

Clear

Date