AFFORDABLE HOUSING

DELRAY HOUSING GROUP, INC.
WAITING LIST APPLICATION
82 NW 5th AVENUE, DELRAY BEACH, FLORIDA 33444
(561) 272-6766

HEAD OF HOUSEHOLD INFORMATION:

FemaleMale
OTHER MEMBERS INFORMATION: (Include all adults and children)
FM
FM
FM
FM
FM
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.