Woodridge Housing Authority                                Housing Assistance Application 
The information provided in this form will be used to place an applicant on the waiting list for housing assistance with the Woodridge Housing Authority. Completing this application does not guarantee eligibility.  Information provided within this form is subject to verification. 
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Email *
Head of Household- First and Last Name *
Head of Household- last 4 of social security number *
Head of Household- Phone Number *
Preferred method of contact  *
Select all that apply
Required
Emergency Contact Phone Number
Applicants may opt to have an emergency contact listed. In the event that an applicant cannot be reached by phone or mail, WHA will contact the emergency contact person listed above. 
WHA will make three attempts to get in contact with an applicant once his/her name reaches the top of the list. After three attempts, the applicant's name will be removed from the waiting list. 
Physical Address  *
Mailing Address  *
Are you a resident of Sullivan County? *
Is the Head of Household over 50 years old? *
Is the Head of Household employed? *
Are any other members of the household employed? *
What is the total gross monthly income for the family? *
Total gross monthly income is the total amount of all income that comes into the household before taxes or other deductions. This includes earned and unearned income. 
Examples- wages from job, child support, social security, pension, alimony, cash income, welfare cash allowance, etc. 
Please list all income- type and amount received  *
Examples- Child support - $200, Job - $2400, Collecting cans - $50, Welfare cash assistance - $700, etc.
Please list the total value of all assets *
Examples- Checking account - $500, CD - $1,000, Owned property - $10,000, etc. 
How many people are in your household? *
Name and date of birth for all members of the household.  *
Example:
1. Timmy Tooth, 1/1/2000
2. Betty Househunter, 2/2/2000
Are all members of the household citizens of the United States of America? *
Has any member of the household ever been evicted from a rental unit? *
Has any member of the household participated in a Public Housing assistance program such as Section 8, Low Income Public Housing, or other rental subsidy programs? *
Does any member of the household owe money to a Public Housing Agency? *
Has any member of the household been convicted of a felony? *
Is any member of the household a registered sex offender  *

Under penalty of perjury, I attest that the information provided above is true and correct at the time of application.

WARNING: TITLE 18, SECTION 1001 OF THE UNITES STATES CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLKY AND WILLINGLY MAKING FALSE OR FRAUDULENT STAEMENTS TO ANY DEPARTMENT OR AGENCY OFTHE UNITES STATES.

 *
By typing my digital signature below, I authorize the Woodridge Housing Authority to verify my information in order to determine my eligibility for housing assistance. *
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