Pre-Qualification Survey

Tell us about yourself and your household
Household members (include anyone who lives in the household and considers this location their permanent home)
Establishing Household Eligibility
Rental Arrangement
Utilities
Have you qualified/been approved for any of the following economic assistance programs?
Race/Ethnicity/Gender
Check that category that best describes the Head of Household (can select multiple)
Attestation

I attest to the accuracy of the information provided above.
This application is not complete till supporting documents have been provided.