MESQUITE HOUSING DIVISION PHONE 972.216.6424 FAX 972.216.6429 SECTION 8 APPLICATION FOR RECERTIFICATION IF YOU OR A MEMBER OF YOUR HOUSEHOLD REQUIRES ASSISTANCE OR A REASONABLE ACCOMMODATION IN COMPLETING THIS APPLICATION AND/OR MEETING ATTENDANCE, PLEASE CONTACT YOUR COUNSELOR PRIOR TO THE MEETING DATE. _______________________________________ ______________________ _________________________________ NAME Please Phone Number Email Address ________________________________________________________________________________________________ ADDRESS Street City State Zip Code Household Composition Please list all persons who will be living as part of the household. Use an additional page if necessary. *Participants are not – required to disclose being disabled. However, benefits for disabled household members cannot be provided unless the participant discloses being disabled. ID or Social Relation to Birth Date Current First / Last Name of Disabled Household Member Name Drivers Security Head of Sex Race (Including (Y/N)* Age Absent Parent First Mi Last License # Number Household Year) HEAD OF HOUSEHOLD 1. Household Composition Cont’d.
MESQUITE HOUSING DIVISION PHONE 972.216.6424 FAX 972.216.6429 SECTION 8 APPLICATION FOR RECERTIFICATION IF YOU OR A MEMBER OF YOUR HOUSEHOLD REQUIRES ASSISTANCE OR A REASONABLE ACCOMMODATION IN COMPLETING THIS APPLICATION AND/OR MEETING ATTENDANCE, PLEASE CONTACT YOUR COUNSELOR PRIOR TO THE MEETING DATE. NAME _______________________________________ ______________________ _________________________________ Please Phone Number Email Address ADDRESS ________________________________________________________________________________________________ Street City State Zip Code Household Composition – Please list all persons who will be living as part of the household. Use an additional page if necessary. *Participants are not required to disclose being disabled. However, benefits for disabled household members cannot be provided unless the participant discloses being disabled. Household Member Name First Mi Last ID or Drivers License # Social Security Number Relation to Head of Household Sex Race Birth Date (Including Year) Current Age Disabled (Y/N)* First / Last Name of Absent Parent HEAD OF HOUSEHOLD 1. Household Composition Cont’d.
APPLICATION-FOR-RECERT.docx