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Housing Application Form is a universal standard application applied for a house. If this file is not completed, the application would not be processed. Therefore, the applicant should make sure to sign the last page. Once this file is completed, the applicant can mail or hand carry to local housing authorities at which the applicant wants to apply. Remember to sign the name at the ending of this form.

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©2004 Commonwealth of Massachusetts Page 1 of 8 Revised November 2008
Department of Housing & Community Development
Universal STANDARD Application for
State-Aided Public Housing,
MRVP, & AHVP
This box is for Office Use Only
Date of Receipt:
Time of Receipt:
Control Number:
Barrier free:
First Floor:
Elderly Handicapped:
Race and/or Ethnicity:
Priority /Preference Category:
Language:
Incomplete applications will not be processed. Please complete all information requested on the
application. If a question is not applicable, please write N/A. Make sure you sign the last page. If you need
additional space to provide an answer, please attach an additional sheet(s). Once completed please
mail or hand carry to local housing authorities at which you want to apply. Please check the list of
local housing authorities for availability of family or elderly/non-elderly handicapped housing.
1.
us
Apt No:
State
Zip:
Cell Phone
Work Phone
Apt No:
State:
Zip:
2.
Type of Public Housing You are Applying For: Elderly Non-Elderly, Handicapped
Congregate Elderly/Handicapped Family MRVP AHVP
Note: To be eligible for elderly/handicapped housing you must be at least 60 years old or a person with a handicap. If
you have a handicap, the handicap must be other than a history of alcohol/drug abuse. If you have a handicap, you must
provide certification by a doctor clearly stating that you have a handicap and it is expected to be of long and indefinite in
duration lasting at least six months. In addition, the LHA will need to determine that certain special architectural features
OR low rent housing is not available in the private market AND that the applicant is faced with living in an institution or
decadent substandard housing OR the applicant is paying excessive rents.
3.
If you want to apply for emergency Housing you must select one of the categories below:
Note: To be eligible for Emergency applicant status you must be “homeless,” which is defined by state regulations as: an
applicant who is without a place to live or who is in a living situation in which there is a significant, immediate and direct
threat of life of safety that would be alleviated by placement in an appropriate unit, who has not caused or substantially
contributed to the situation, who has made reasonable efforts to prevent of avoid the situation and to locate alternative
housing, and who is displaced from is/her primary residence for one of the following reasons. Please check the reason
that applied to your situation.
Displaced by Natural Forces (i.e. Fire, Flood, Earthquake)
Displaced by Public Action (i.e. Urban renewal, eminent domain)
Displaced by Public Action (i.e. Condemnation of home, code violations)
Displaced by No-fault of housing, Severe Medical emergency and/or Victim of Abuse (domestic violence)
where the housing situation significantly contributes to or is direct threat to the life and safety of the applicant.
If you have selected one of the above emergency categories in this section, you must complete an EMERGENCY
APPLICATION in addition to this Standard Application. All emergency applications must be accompanied by
third party written documentation.
Housing Application Form
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