Rental Assistance Preliminary Application for Rental Assistance,
Homeless Preference and Disability Preference
 (Please print and mail, deliver or fax to address below.)
Number of people who will live in this household __________
Are any additions to this number expected? Yes ___ No ___ If so, approximate date ______
Sources of income for all occupants: (Check all that apply)
DHS _______ Soc. Sec. _______ Employer _______ Other _______
Total monthly household income for all occupants __________________
Are you a citizen of the United States? Yes ___ No ___                          
   For office use only
                  /       /       /       /     

1.  List each person who will be living in your household. List the head of household first.
Last Name First Name MI Age Sex Relationship To You Social Security Number
             
             
             
             
             
             

2.  The Oklahoma Housing Finance Agency is an Equal Opportunity Housing Agency and cannot discriminate on the basis of race, creed, national origin or sex. Information on race and ethnicity is used for statistical purposes only and will not affect your eligibility for assistance. (Please check which one applies to the head of household.)
White ___ Black ___ American Indian/Native Alaskan ___ Asian/Pacific Islander ___
Is the head of household Hispanic? Yes ___ No ___
3.  Current mailing address: __________________________________, Apt. # __________
City ____________________________ State _________  Zip ___________  County _______________________ 
Telephone: Area Code __________ Number ____________________
4.  Are you or your spouse 62 years of age or older?  Yes ___ No ___
5.  Are you or any member of your household disabled?    Yes ________ No ________
6.  Are you homeless?   Yes ________ No ________

Mail Application to:
Oklahoma Housing Finance Agency - P.O. Box 26720 - Oklahoma City, OK 73126-0720
100 N.W. 63rd Street, Suite 200 - Oklahoma City, OK 73116
Fax: (405) 879-8822

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