REQUEST TO ADD A FAMILY MEMBER

HEAD OF HOUSEHOLD___________________________________________________

SS #_______________________________  PHONE #_____________________________

ADDRESS________________________________________________________________

Please complete the following to add a family member.  Completion of this form does not guarantee that the request will be granted.  You will receive a written response regarding the approval or denial of this request.

Name of the person you wish to add ________________________________________________

Relationship to you  ______________________________Date of birth_____________________

  SS# _________________________________

What income does this person have?________________________________________________

Current address of person you wish to add? __________________________________________

Why do you want to add this person to your household? ________________________________

Documents Needed

 Birth Certificate ______ Social Security Card ______  Picture ID (18 and over)______

Information Release Form (HUD-9886)______  Applicant/Tenant Certification  ______

Declaration 214 Form ______     ***legal proof of guardianship or custody (a notarized letter is not considered legal proof***______

Members 18 and over must sign the Release form, Applicant/Tenant Certification and Declaration 214.

** A background check will be conducted on anyone 18 and over to verify that they have no criminal history before request will be considered.**

Signature___________________________         Date:______________________