Rental Assistance Application Form

LCHA HUD Section 8 Housing Rent Assistance Program

1415 S. Odell Ave. Marshall, MO 65340

(660) 886 7476

This application will be used to determine Applicant eligibility for federally subsidized rental assistance programs offered by MVCAA.

Applicant General Information

Applicant Name/Head of Household(Required)

Residential Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing address is different

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone

Alt Phone

Email(Required)

Residency Status

You are considered a Non-Resident of the MVCAA jurisdiction, if you answer yes to either question A or B.

Yes

B. Do you live within the city limits of Marshall/Carrollton?(Required)

Lafayette County Housing Authority cannot issue Housing Choice Vouchers within the city limits of Marshall or Carrollton. If you wish to reside within those city limits, please contact Marshall Housing Authority or Carrollton Housing Authority. You may continue this application if you wish to move to a different location.

Yes

Residency Status(Required)

Resident

Non-Resident

County (Live/Work)(Required)

Indicate the county where you now live or work. Proof must be provided before preference will be given. Refer to instruction on back page of acceptable documentation.

Are you currently homeless?(Required)

Yes

Household Composition

List the Head of Household and other members who will be living in the assisted home.

Household Members(Required)

All household members must be added including yourself.

Full Name

Relationship to Head of Household

Sex (M/F)

Race (see below)

Ethnicity (see below)

Social Security Number

Birth Date

Age

Disabled/Handicapped (Yes/No)

Race

WHITE (W) BLACK (B) AMERICAN INDIAN (AI) ASIAN/PACIFIC ILANDER (AP)

Ethnicity

HISPANIC (H) NON-HISPANIC (NH)

Household Income Summary(Required)

For each type of income that your household receives, list the source of income and the monthly GROSS amount.

Name of Person Receiving Income

Source of Income

Monthly Amount

Annual Amount

General Questions

All questions must be answered.

Have you ever violated a previous family obligation in connection with a HUD program?(Required)

Yes

Do you owe any money to a Public Housing Authority?(Required)

Yes

Have you or any household member been arrested, charged or convicted in drug-related or violent criminal activity within the last 3 years?(Required)

This includes the illegal manufacturing, sale, distribution, use or possession with intent to manufacture, sell, distribute or use of a controlled substance.

Yes

Proof of Residency

You may take a photo of your document and upload it for proof of residency. The entire document must be removed from the envelope and visible. Please make sure your uploaded document is clear and easy to read or your application may be rejected.

Please keep in mind that an application isn’t complete if you don’t provide us with an official proof of residence.

Examples of proof of residency are (but not limited to): mail from a local/state/federal government program, mail from school, or a bill with your physical street address.

Mail from any subscriptions/memberships will not suffice.

If you are homeless, you must provide us with a letter with information of where you’re physically living at. If you’re staying at a homeless/women’s shelter, please have that organization write you a letter with information of your stay. If you’re staying with another individual/family, please have that individual/family member write you a letter with information of your stay. Please make sure there’s a signature, date, and contact information (on your letter) for the organization/individual.

You may take a photo of your document and upload it for proof of residency. Please make sure your uploaded document is clear and easy to read or your application may be rejected.

Proof of Residency(Required)

A COPY OF THE APPLICANT'S PROOF OF RESIDENCY MUST BE ATTACHED

Max. file size: 200 MB.

Certification

I certify that all information contained in this application for housing assistance is true, accurate and complete. I understand that misrepresentation of any information may disqualify this application.

Completion of this application doesn’t determine eligibility for the Housing Choice Voucher Program.

Housing Choice Voucher Application