SECTION 8 PROJECT BASED APPLICATION

 VILLAGE SQUARE ELDERLY
WAITING LIST APPLICATION (62 Years & Older) ONE BEDROOMS ONLY
82 NW 5th AVENUE, DELRAY BEACH, FLORIDA 33444
(561) 272-6766 

    HEAD OF HOUSEHOLD INFORMATION:

    FemaleMale
    SPOUSE/OTHER ADULT INFORMATION:

    FemaleMale
    FOR STATISTICAL PURPOSES ONLY:

    WhiteBlack/African AmericanAmerican Indian/Alaskan NativeAsianNative Hawaiian/Other Pacific IslanderHispanic or LatinoNon-Hispanic/Latino
    I CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE AND COMPLETE. I UNDERSTAND THAT SUBMISSION OF FALSE INFORMATION OR MISREPRESANTATION MAY RESULT IN LOSS OF ELIGIBILITY TO PARTICIPATE IN THE SECTION 8 PROJECT BASED PROGRAM. ANY CHANGES IN CHANGES IN ADDRESS MUST BE SUBMITTED IN WRITING.