Pre-Application

Thank you for your interest in our Housing Programs. Once you have submitted your pre-application, it is very important you notify our office, in writing, if your correspondence address changes so we can contact you when you reach the top of the wait list.

The Pre-Application is comprised of the following four sections along with a certification statement. If you need assistance completing this form, please contact our office at 541-673-6548.

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Program Selection

Housing Program *

Section 8 - Family Choice Voucher

Contact Information

First Name *

Last Name *

Mailing Address *

City *

State *

Zip Code *

Phone Number

Please enter area code XXX-XXX-XXXX

e-mail address

Does this household require wheelchair accessibility?

Yes

Household Member Information

Gross Household Income Per Year *

Number of household members *

1. Head of Household (HOH) Name *

HOH Birthdate *

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HOH Gender *

Male

Female

HOH Disability Status

I have a disability. I have a physical or mental impairment that substantially limits one or more major life activities or I have a record if such impairment.

HOH Ethnicity

Hispanic

Non-Hispanic

I decline to report

2. Household Member #2 (HM #2) Name

HM #2 Birthdate

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HM #2 Gender

Male

Female

HM #2 Disability Status

I have a disability. I have a physical or mental impairment that substantially limits one or more major life activities or I have a record if such impairment.

HM #2 Ethnicity

Hispanic

Non-Hispanic

I decline to report

3. Household Member #3 (HM #3) Name

HM #3 Birthdate

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HM #3 Gender

Male

Female

HM #3 Disability Status

I have a disability. I have a physical or mental impairment that substantially limits one or more major life activities or I have a record if such impairment.

HM #3 Ethnicity

Hispanic

Non-Hispanic

I decline to report

4. Household Member #4 (HM #4) Name

HM #4 Birthdate

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HM #4 Gender

Male

Female

HM #4 Disability Status

I have a disability. I have a physical or mental impairment that substantially limits one or more major life activities or I have a record if such impairment.

HM #4 Ethnicity

Hispanic

Non-Hispanic

I decline to report

5. Household Member #5 (HM #5) Name

HM #5 Birthdate

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HM #5 Gender

Male

Female

HM #5 Disability Status

I have a disability. I have a physical or mental impairment that substantially limits one or more major life activities or I have a record if such impairment.

HM #5 Ethnicity

Hispanic

Non-Hispanic

I decline to report

6. Household Member #6 (HM #6) Name

HM #6 Birthdate

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HM #6 Gender

Male

Female

HM #6 Disability Status

I have a disability. I have a physical or mental impairment that substantially limits one or more major life activities or I have a record if such impairment.

HM #6 Ethnicity

Hispanic

Non-Hispanic

I decline to report

7. Household Member #7 (HM #7) Name

HM #7 Birthdate

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HM #7 Gender

Male

Female

HM #7 Disability Status

I have a disability. I have a physical or mental impairment that substantially limits one or more major life activities or I have a record if such impairment.

HM #7 Ethnicity

Hispanic

Non-Hispanic

I decline to report

Certification *

I certify that I have given true and complete information and I understand I must provide verification of Social Security Numbers for every household member when I reach the top of the waitlist and my eligibility is being determined.

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Pre-Application

Section 8 Housing Choice Voucher (HCV)