Decatur Housing Authority

1-800-4236

Family Public Housing Pre Application

 

We use this application form to determine if you are eligible for Housing Assistance and to place you on a waiting list. If you have questions or need help completing this form, please contact our Applications Department.

 

Important!  Please Read.

This is for Public Housing in Decatur ILLINOIS.   


The waiting lists for the 2, 3, 4 & 5 bedroom are closed.


 

 

 


IMPORTANT!!! PLEASE READ! LIST YOURSELF FIRST!! List each person who will live with you, using correct legal names. Incomplete applications will not be accepted. Please complete all sections of the application.


Last Name First Name MI Relation To You SEX Social Security Number Birth Date Race Are you Hispanic
or Latino?		 Disabled?

HEAD***

 Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No
Yes  No Yes  No

***Must be at least 18 years old or a court-ordered emancipated minor.


We only contact by mail. Where do you want your mail sent?

Street:

City, State, Zip:



Where are you residing (living)? (If different from where you mail is sent)

Street:

City, State, Zip:



Applicant's phone number or message phone:



Marital status:



If you listed dependent children above, are they in your custody?

Yes  No

Are you pregnant?

Yes  No

Do you currently reside and/or work in Macon County?

Yes  No

Does anyone in your household require specific accommodations?

Yes  No

If yes, please tell us what you need.



Is any adult on this application currently enrolled in an educational/training program?

Yes  No

If yes, name of person is:



List ALL income earned or received by everyone who WILL BE living in your household:

Household member Income From: How Much? How Often?


Are you and all other persons listed on the application citizens of the United States or legal immigrants?

Yes  No

If not, who is not:



Do you owe Decatur Housing Authority or any subsidized housing program money?

Yes  No

If yes, did you receive an Earned Income Disallowance?

Yes  No



Are you or any member of your household on probation or parole?

Yes  No

If so --

Name Crime: Where? When?


Are you or anyone in your household required to register on any sex offender list?

Yes  No

If yes, in which state and please explain:

Please take the time to tell us how you heard about Decatur Housing Authority.

  • Television Ad
  • Newspaper
  • Booklet or Pamphlet
  • Family or friend
  • Telephone book
  • Internet

Others:




I certify that the information given to the Authority is accurate and complete to the best of my knowledge and belief. I/we understand that false statements and/or information are punishable under Federal Law. I/we also understand that false statements and/or information are grounds for termination of housing assistance and termination of tenancy