Voucher – Housing Choice Voucher

Housing Choice Voucher


Voucher Type:


DHA Client Number (Optional):

Alternate Phone:
Date of Birth:
Voucher Street Address:
Voucher City:
Voucher State:
Voucher Zip Code:




Voucher Bedroom Size Eligibility:
How many children in household?:
Worked with ICP?:
Would like housing search assistance?:
Foreclosure:
Abatement:
Transportation:
Family:
Job:
School:
Utilities:
Reasonable Accommodation:
Domestic Violence:
Crime:
Fire:
Location:
Repairs:
Landlord Selling Property:
Voucher Size:
No Longer Accepting Section 8:
New Voucher:
Other:

Other reason for relocating:
Optional Race Data:
Optional Ethnicity Data:
Consent for Release of Information:

Typed E-signature: