LHC Housing Services Application UPDATE form

THIS IS NOT AN APPLICATION FOR
HOUSING SERVICES

Please DO NOT fill out this form if you have not already submitted a full Housing Services application. This form is only to update your existing information. If you submit this form without having an active application on file, it will NOT be processed.

Please only use this form to update any pertinent information for applicants already on the Housing Services waitlist. If you have any issues filling out this form, please email us at housingservices@laurel.org.

EQUAL HOUSING OPPORTUNITY: LHC complies with the Fair Housing Act. The information in this packet will assist us in helping you address past barriers to successful tenancy so that when you transition to independent living, you will have removed common barriers to housing.

Have you filled out an original Housing Services application or update form within the last year?

Housing application update forms are only accepted for individuals who have active housing applications currently on file with Laurel Hill Center.

Are you currently engaged in Laurel Hill Center services?

Applicant's Name

First NameLast Name

Date of Birth

Date

Gender

Pronouns

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Complete Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred method of contact

Other

May we leave a message at this number?

Will you require an accommodation due to a physical disability? (If yes, documentation will be required and verified if offered a housing opportunity)

Describe the nature of the requested accommodation:

Do you have a documented companion or service animal? (If yes, documentation will be required and verified if offered a housing opportunity)

Do you have a pet(s)? (If yes, licensing and up-to-date vaccination records will be required and verified if offered a housing opportunity)

Additional Household Members: (List any and all additional people (if any) who will be living with you)

Rows	Name	DOB	Gender	Relationship
Person 1
Person 2
Person 3
Person 4

Do you have a documented live-in aide?

Who are you working with at Laurel Hill Center? (If Applicable)

Household Income (select all that apply)

Other

Total monthly household income

Payee Name (if applicable)

First NameLast Name

Payee Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

*By providing payee information and signing this application, you authorize LHC to contact your Payee regarding security deposits, rent, or other financial requirements for LHC’s Housing Programs.

Current Housing Status

Please type your initials here indicating that you are aware that you must have BOTH a current (not expired) ID and proof of your Social Security Number before you may be presented with a housing opportunity. If you do not have one or either of these documents, please work on obtaining them now to avoid delays or ineligibility. Once you have them, please send a copy to the housing team at housingservices@laurel.org.

★ By signing this application update form, I understand that I will be placed on a waiting list. Applicants will be prioritized according to established contract requirements, policies, and procedures. I also understand that it is my responsibility to contact LHC should my contact information, household composition, or eligibility information change. Failure to do so may result in loss of opportunity to apply for housing assistance or denial of housing assistance due to household or eligibility changes.

CERTIFICATION: The information provided on this application update form is complete and true to the best of my knowledge. I understand that providing false information may lead to denial of this application, to termination of rental agreement (if falsehood is discovered after move-in), or to criminal prosecution. I understand that admission is conditioned upon eligibility criteria set by state law, this site’s Tenant Selection Plan, and my payment of applicable rent and security deposit in advance of move-in. I understand that, should I be accepted for admission, I must not maintain any other residence anywhere after I move in. I further understand that this information will be verified and that I must keep the application current by notifying Laurel Hill Center of changes in address and preferential status.

Name

Today's Date

Date

LAUREL HILL CENTER