Pre-Application for Affordable Housing Pre-Application for Affordable Housing Household MembersHousehold InformationQuestionnaireIncome & AssetsMiscellaneous InfoSignature(s) If you are human, leave this field blank. Is your request for housing due to the need of temporary housing due to a presidentially-declared disaster? Yes No Optional Responses Below I choose to NOT complete the Ethnicity & Racial data. I choose to NOT complete the Male/Female data. Household Members Add up to 5 Name (First, Middle Initial, Last) Relationship to Head of Household Gender - Optional Male Female Social Security Number Date of Birth U.S. Military Veteran Yes No Ethnicity Data - Optional Hispanic Not-Hispanic Racial Data - Select all that apply - Optional American Indian Alaska Native Asian Black African American Native Hawaiian Pacific Islander White Add Household Member Remove Household Member Next Address 223 West 700 South Suite C Salt Lake City, UT 84101 Phone (801) 364-6117 Email info@unphc.org
