Rental Assistance Preliminary Application for Rental Assistance,
Homeless Preference and Disability Preference
(Online Submit Form)

Today's Date
Number of people who will live in this household 
Are any additions to this number expected?    If so, approximate date:
Sources of income for all occupants: (Check all that apply) 
Total monthly household income for all occupants 
Are you a citizen of the United States? 

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

 Head of Household

 



  

    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 eligibilty for assistance. 

(Please check the one that applies to the head of household.)
     
Is the head of household Hispanic?
     

      3.  Current mailing address  
        Apt. Number
       
City
         State
         Zip
         County 
Telephone: Area
        Number
       

        

          4.  Are you or your spouse 62 years of age or older?
           

5.  Is any member of your household disabled?
           

6.  Are you homeless? 
           

          

          7. 
          Were you affected by Hurricane Katrina? 
          
           

      Please review your information. Once you click on the submit form button 
      your information can not be changed. 
      

  

      

      Please print a copy of the Form Confirmation 
      Page for your records.


      



      
Copyright © 2005 Oklahoma Housing Finance Agency. All rights reserved. 

      Online Form
Revised: 
      05/28/08