AHH Pre-Application

AFFORDABLE HOUSING HOLDINGS, INC
Pre-Application
Please Choose a Property
Applicant's Name:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Present Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Household Composition: List all members who will be living in the unit with you including yourself. Give the relationship of each family member to the head.

Rows	Full Name	Relationship	Birth Date	Age	Sex (M/F)	Social Security Number	Full-Time Student	Race
1.
2.
3.
4.

*A full-time student is defined as someone 18 years of age or older, who has been or will be a full-time student for 5 months this year, not necessarily consecutive.
Is a baby expected?
If yes, list due date.

MonthDayYear
Date
What is your combined total gross household annual income?
Applicant Certification: I/we authorize the Allegheny County Housing Authority to access/obtain from any person, agency or service, regarding my background which may assist in determining whether I have 1.) a criminal history, and/or 2.) an outstanding balance to any other Housing Authority. I/We certify that the information given to the Allegheny County Housing Authority on household composition and income is accurate and complete to the best of my/our knowledge and belief. I/We understand that false statements or information are punishable under Federal Law. I/We also understand that false statements or information are grounds for termination of housing assistance and termination of tenancy.
ALL ADULT MEMBERS OF THE HOUSEHOLD (18 YRS OR OLDER) MUST SIGN BELOW.
Head of Household Signature
Date

MonthDayYear
Date
Spouse or Co-Head Signature
Date

MonthDayYear
Date
Signature
Date

MonthDayYear
Date
Signature
Date

MonthDayYear
Date
NOTE TO APPLICANTS: If you believe you have been discriminated against, you may call the Equal Opportunity National Toll Free Hot Line at 800-424-8590.

Revised 5/29/2020
Should be Empty:

AFFORDABLE HOUSING HOLDINGS, INC

Pre-Application

ALL ADULT MEMBERS OF THE HOUSEHOLD (18 YRS OR OLDER) MUST SIGN BELOW.