Pre-Application For Housing

Housing Authority of Pikeville

Type of Assistance Needed * Please click the button for the type of assistance you are requestingSection 8PHABoth
Head of Household Name * Please type the head of household name
Date of Birth * Please enter the head of household date of birth
Social Sec. Number * Please enter the Social Security Number of the head of household (all numbers)
Race * Please click the button to signify your raceWhiteBlack/African AmericanOther
Sex * Please enter head of household sexMaleFemale
Ethnicity * Please enter head of household ethnicityHispanicOther
Add other household members name Please enter the name of additional household members
Relationship to Head of Household Relationship of other family member to head of householdSpouseChildOther
Other member date of birth Enter birthdate of other household member
Other member Social Sec. Number Enter SSAN of other household member
Other member sex Please enter sex of other household memberMaleFemale
Add other household members name
Relationship to Head of HouseholdSpouseChildOther
Other member date of birth
Other member Social Sec. Number
Other member sexMaleFemale
Add other household members name
Relationship to Head of HouseholdSpouseChildOther
Other member date of birth
Other member Social Sec. Number
Other member sexMaleFemale
Add other household members name
Relationship to Head of HouseholdSpouseChildOther
Other member date of birth
Other member Social Sec. Number
Other member sexMaleFemale
Current Physical Street Address * Please enter your current address - street information only
City * Please enter your city
State * Please enter your state
Current Telephone Number * Please enter your current telephone number (numbers only)
Mail Address (blank if same as physical) Please enter your mailing address unless it is the same as your physical address
Mailing Address City
Mailing Address State
Estimated Total Family Income * Please enter your total family income (numbers only)
Income RateHourlyWeeklyMonthlyYearlyOther
Income Source * Please click on the button to show your income sourceWagesDisabilityChild SupportSocial SecurityOther
Disabled? * Are you disabled?YesNo
If disabled, is disability physical?YesNoNot Applicable
Does the family have an immediate and urgent need for housing? *YesNo
Why do you need assistance? Please enter in a few words why you require assistance
Have you lived in public housing before? *YesNo
If Yes, where? If you have lived in public housing before, please tell us where
Have you received Section 8 assistance? *YesNo
If Yes, where? If you have received Section 8 assistance, please tell us where
Please enter name, address, and phone number of current landlord
Please enter name, address, and phone number of LAST landlord
Additional Comments

Type the following: For security purposes, please type the letters in the image.