Housing Authority of Savannah
Application for Housing Choice Voucher (Section 8 / PBV)

Instructions: Everyone listed on this application MUST be at least 62 years old for the application to be accepted. Press the TAB key to move from field to field or use your mouse and click the desired field. ALL applicable fields must be filled in for your application to be processed. ALL dates must include a 4-digit year. If you do not receive a confirmation page for printing or an error occurs, please complete again and resubmit.
******* Do not mail this form !! Send electronically with the button at the bottom of the form. ******
Application Information (Head of Household ):  

First Name
MI
Last Name 		- -
Social Security Number

Address
Apt 		/ /
Birth Date (mm/dd/yyyy)
Birth: City
State

City
State
Zip
Email Address 		- -
Telephone Number
Please select all that apply ( Head of Household):
Ethnicity:   Gender:  
Hispanic   Male  
Non-Hispanic Female    
Please select one or more you consider yourself to be ( Head of Household):
White Black / African American Native Hawaiian / Other Pacific Islander
Asian American Indian / Alaskan Native    
Please answer all the questions below (click with mouse):
Yes No Are you or your spouse a person with disabilities / handicap?  
Yes No Are you a US citizen?    
Yes No Are you a non-US citizen with eligible immigration status?  
Please select one or more Apartment Complex for which you would like to be considered:
Rose of Sharon (322 East Taylor Street)
Gross Monthly Household Income ( round to nearest dollar):
Wages $    
Social Security Income $    
TANF $    
Other Income $    
Income from Assets $    
Household Information: list ALL persons (other than you) who will be living in the household ( must be at least 62 years of age )
Relation: S = Spouse ; A = Adult 
Relation
(S,A)
First Name
Last Name
Social Security Number
Birth Date mm/dd/yyyy
Birth Place:
City, State
Gender M / F
Handicap
Disabled
S A Y N
S A / / Y N
S A / / Y N
S A / / Y N
**DO NOT MAIL THIS FORM ** **Click Submit to send or
Reset to cancel and clear form**