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Dear Applicant: The application you are about to complete is for Public Housing units in Tulsa, Oklahoma. The approximate waiting period for Public Housing is 6 to 12 months. You may visit our website at www.TulsaHousing.org for additional program information.
By submitting this application, you authorize the Tulsa Housing Authority to complete a criminal background check and verify information and current accounts from the local gas utility company.
Part 1: Head of Household
Social Security Number:
Date of Birth:
Are you anemancipated minor?
ex. (xxx) xxx-xxxx
Free E-mail Account
Other Phone Type:
Ethnicity (Check one box)
Race (Check all that apply)
Black/ African American
American Indian/ Alaska Native
Native Hawaiian/ Other Pacific Islander
Racial and ethnic data for statistical purposes only.
Do you qualify for a reasonable accommodation due to a disability?
Part 2: Household Information
Legal Address (Where you currently live)
Address Line 1:
Address Line 2:
Mailing Address (If different from Legal)(Where you currently receive mail)
Note: If your legal or mailing address changes, you must notify the Housing Authority in writing to maintain your waiting list status.
List information for adults first, then children under age 18. Use "F" or "M" to indicate sex. If a household member qualifies for a reasonable accommodation due to a disability select "Y", if not, select "N". List relationship of each person to the Head of Household.
Date of Birth
Part 3: Family Income and Assets
List total gross income (before taxes) and payments received by each family member age 18 or older for wages, military pay, pensions, social security, SSI, welfare, child support, unemployment, business, profession, or any other source. Include payments made to family members age 18 or older on behalf of other family members under age 18.
If Income is from WagesList Name and Address of Employer
List total cash value and total income received for assets owned by all family members.
Type of Asset
Cash Value of Asset
Annual Income Received from Asset
Stocks, Bonds, CDs, Investment
Part 4: Eligibility and Preferences
Your response to the following statement will help determine your eligibility for rental assistance and if you are entitled to a preference when placed on the program's waiting list. Select the appropriate responses for each question below.
Q1: The Head of Household and/or spouse is working and the working persons needs are not included in any TANF payments the family may be receiving.
Q2: The Head of Household or Spouse is 62 years of age or older.
Q3: The Head of Household and spouse are active participants in educational or training programs that are designed to prepare individuals for the job market.
Q4: The applicant family is residing in a public or private shelter as a result of domestic violence and has had actual or threatened physical violence directed against the applicant or applicants family by a spouse or other household member who was living in the unit with the family.
Q5: The applicant family with dependent children is homeless and is residing in a private or public shelter.
Q6: The applicant family is residing in a public or private care facility as a result of a severe illness or disability and with housing could transition back into the community to live independently or with the assistance of an aide.
Q8: The applicant family has one or more family members who are a person with disabilities.
Q9: The applicant family has a member who is between the ages of 50 and 61.
Q10: Are you or anyone in your household pregnant?
Part 4: Supplemental and Optional Contact Information
Part 5: Supplemental and Optional Contact Information
You have the right to include as part of your application contact information for a person or organization that may be able to help you resolve any issues that may arise during your tenancy or to assist in providing any special care or services you may require should you become a tenant. You are not required to provide this contact information, but if you choose to do so, please click the "Add Contact" button below to complete the form.
Name of Contact Person
Check this box if you choose not to provide the contact information.
Part 5: U.S. Citizenship Notification and Certification
Part 6: U.S. Citizenship Notification and Certification
Head of Household Social Security Number:
Head of Household Date of Birth:
Head of Household E-mail:
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