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Request to add family member

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HEAD OF HOUSEHOLD___________________________________________________

SS #_______________________________  PHONE #_____________________________



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:______________________


Warning Title 18, Section 1001 of the United States Code, state that a person who knowingly and willingly makes false or fraudulent statements to any department or agency of the United States is guilty of a felony.