NEW APPLICANT

Online Waiting List Application

Enter the information below. Click HELP for item description and help screens.
Click CONTINUE when completed.(All information is required unless otherwise noted.)

Eligibility: Applicants must be 18 years of age or older, must qualify as a family or be of disabled or elderly status, and
must meet HUD income and other requirements. (See attached Eligibility Information for screening & income guidelines).
DSHA does not discriminate based upon race, color, creed, national origin, sex, age, handicap, or familial status.

Si usted necesita asistencia en español para llenar esta solicitud, o con algún otro programa de asistencia de DSHA, por favor llame al (302)739-4263 ext. 215.

If you need language assistance to fill out this application and/or any other DSHA housing assistance program, please call (302)739-4263 ext. 215.
If you have already applied to this waiting list, PLEASE DO NOT REAPPLY. This application is for new applications only. You can edit your existing application by clicking here.

Head of Household Information
Head of Household SSN: Do not use dashes. ex: 123456789
eMail Address: (optional/recommended)
Last Name:
First Name:
MI:
Date of Birth: (MM/DD/YYYY) ex. 01/05/1960 for January 5th ,1960.
Sex MALE FEMALE
Street Address:
City:
State:
Zip Code:
Phone:
 Include Area Code & Do not use dashes. ex: 123456789
Annual Family Income*: $
 *Total annual income of all persons in the household. Includes employment, public assistance, social security, SSI, pensions, veterans benefits, alimony, child support, unemployment, workman’s comp, military pay, and lottery winnings.
Elderly Status: Yes No (57 or Older)
Disable Status: Yes No
Ethnicity:
Race:


List all other occupants who will be living in the unit:
Name
(First & Last)		 Date of Birth
(MM/DD/YYYY)		 Sex Relationship to Head of Household
1.
2.
3.
4.
5.
6.


Program Assignment: Based on the information you submit on this application, YOUR NAME WILL BE PLACED ON ALL WAITING LISTS FOR WHICH YOU QUALIFY. (See Housing Program information) Verification of your information will take place prior to assistance being offered. Unless EXEMPT, all applicants are required to participate in DSHA's Moving to Work (MTW) Program. Exemptions are granted for reasons listed below.
Exempt from MTW - Check here if claiming Exemption to DSHA’s MTW Program.
On what grounds are you claiming this exemption?(Check all that apply)
Head or spouse 57 years of age or older or Disabled
Head or spouse disabled or Head of household must care for disabled child or adult in home.


Place check mark(s) below to request DSHA preferences. Check ALL that apply.
Residency Preference - Living or working in Kent or Sussex County.
Preference Zip:
Employment Preference - Head of household or spouse/co-head is working 20 or more hours per week.(The elderly and disabled automatically will be given a preference equal to employment.)
Veteran's Preference - U.S. Veteran, or eligible family member of deceased veteran if the death was service related.
DD214 field 12b (Seperation Date) or DD1300 field 4d(Deceased Date):
No Previous MTW - Check this preference if the head of household and spouse/co-head have never participated in the MTW Program.


Do you or any member of your family have conditions that require: Check ALL that apply.
A Separate Bedroom
Unit for Vision Impaired
A Barrier-Free Apartment
Unit for Hearing Impaired
One-Level Unit
Bedroom/Bath on 1st Floor
Physical Modifications to a Typical Apartment


Can you and all of your family members go up and down stairs unassisted? YES NO
Will you or any of your family members require a live-in aide to assist you? YES NO
By checking this box, I certify that I am the person identified in this application and that all information provided herein is true and correct. I further acknowledge that I have read and understand this application and all attachments. I understand that incomplete or false answers may be grounds for ineligibility or lease termination. I hereby consent to allow the Housing Authority subscribed to herein to conduct an investigation of the information stated on this application. I understand that it is my responsibility to keep the information on my application up to date. I understand that my name will be removed from ALL waiting lists if I cannot be contacted by mail. I agree to accept the terms and conditions of this document. I understand that this document is legal and binding, and false information or impersonation of another could lead to fines, imprisonment, and/or both.

Electronic Signature:
  • I have agreed to submit an application by electronic means.
  • I understand that I can be prosecuted if I provide false or misleading information.
  • I understand the questions on this application and the penalty for giving false or misleading information.
  • I certify, under penalty of perjury, that all my answers are true, correct and complete to the best of my knowledge.
  • I understand that an electronic signature has the same legal effect and enforceablility as a written signature on an application.
    I certify this application.
    If the box is not checked, your application WILL NOT be processed.
    • Click CONTINUE below to complete this application process.

    Delaware State Housing Authority
    Call the office for more information.
    Toll Free: 1-888-363-8808
    TDD: (302)739-3783