FULL AGENDA PACKET_2021-07-20 - Laserfiche WebLink

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TENANT INFORMATION FORM Please review and complete this form. This information will help us determine your assistance. Head of Household Unit Address Unit City, State, ZIP Mailing Address (if different than above) Telephone Number: Telephone Number: E-mail Address Part 1: Household Information ❑ Home I] Work Cell L Other ❑ Home I] Work L Cell L Other would like to receive correspondence via e-mail. Indicate the current status of all adults and children that will live in the housing unit to be assisted. Add new members in the space provided below, including the full Social Security Number for each. Enter one of the following codes in box 6 to identify the relationship of each new adult and child listed. H = Head of Household K = Co -Head (Not Married) Y = Youth Under 18 L = Live-in Aide S = Spouse (Married) F = Foster Child/Adult E = Full Time Student Over 18 A = Other Adult 1. Last Name & Sr, Jr, eta 2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation 7. Disabled H F-Yes No S. Ethnicity (Check One Box) 9. Race (Check All That Apply) 10. Social Security Number 11. Living in Household F HlspaniG Not Hispanic/ -] white American Indian/Alaska Native n Native Hawaiian/ other Pacific Islander Yes No Latino Latino Asian Black/African American 1. Last Name & Sr, Jr, site. 2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation 7. Disabled D M L:]F C Yes ` No 8. Ethnicity (Check One Box) 9�. RIace (Check All That Apply) 10. Social Security Number 11. Living in Household Hispanic/ Not Hispanic/ u white L_ American IndiaNAlaska Native U Native Hawaiian/ Other Pacific Islander Yes No Latino Latino Asian L_Black/African American 1. Last Name & Sr, Jr, etc. 2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation 7. Disabled L]M L_]F LYes No 8. Ethnicity (Check One Box) 9�. Race (Check All That Apply) 10. Social Security Number 11. Living in Household Hispanic/ Not Hispanic/ u white American Indian/Alaska Native U Native Hawaiian/ Other Pacific Islander Yes No Latino Latino Asian . Black/African American 1. Last Name & Sr, Jr, etc. 2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation 7. Disabled L-1M L_]F LYes No 8. Ethnicity (Check One Box) 9. Race (Check All That Apply) 10. Social Security Number 11. Living in Household Hispanic/ Not Hispanic/ white L_ American Indian/Alaska Native Native Hawaiian/ Other Pacific Islander Yes No Latino Latino Asian Black/African American ` 1. Last Name & Sr, Jr, etc. 2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation 7. Disabled �M L:]F CYes No 8. Ethnicity (Check One Box) 9. Race (Check All That Apply) 10. Social Security Number 11. Living in Household Hispanic/ Not Hispanic/ Dwhite American IndiaNAlaska Native Native Hawaiian/ Other Pacific Islander -]Asian Yes No Latino Latino Black/African American 1. Last Name & Sr, Jr, etc. 2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation 7. Disabled -]M -]F F-Yes No S. Ethnicity (Check One Box) 9. Race (Check All That Apply) 10. Social Security Number 11. Living in Household Hispanic/ Not Hispanic/ I I /Alaska white American Indian Native _1Native Hawaiian/ Other Pacific Islander Yes No Latino Latino Asian � Black/African American ' City Council 31 - 15 7/20/2021 Page 8 of 29