Opportunity X 10 Housing Application

Please answer all questions honestly. Any untruthful answers may result in your application being rejected.

I attest that all information in this application is true to the best of my knowledge.

Signature: _____________________________

I would like to join this housing and financial opportunity program

(Circle one: Yes / No)

Head of Household Information

Full Name: Current Address: Street Address: Street Address Line 2: City, State, Zip Code: How many years at this address?

Additional Adult Applicant (if any)

Full Name: Current Address: Street Address: Street Address Line 2: City, State, Zip Code: How many years at this address? Number of additional applicants not listed above, including age and gender: Additional applicants under 18, including age and gender: Total number of family members:

Housing and Living Situation

Do you have a pet? Are you currently in public housing? If yes, number of bedrooms: Are you currently in the shelter system? If yes, Housing Specialist Name and Phone Number:

Education and Employment

Education levels and vocational training Applicant: Additional Adult Applicant: Other applicants (including children): Skills: Job/Training Experience: Employment History: How many generations of your family have been on public assistance? Are you and/or other applicants registered to vote? (Circle one: Yes / No) If yes, list who:

Emergency Contact Information

Full Name: Phone Number: Applicant Phone Number: Applicant Email Address: Submit