HOUSING AUTHORITY
Thank you for applying for Public Housing with the King County Housing Authority. Please note that you only need to complete ONE application for Public Housing. Applications must be completed in ink and should be mailed to:
King County Housing Authority Central Applications Processing Center 20126 Ballinger Way NE, PMB # 151 Shoreline, WA 98155-1290
Applications will also be accepted at KCHA management offices. Hours and/or days of operations may vary for individual offices. Applications will NOT be accepted at offices after 12:00 p.m. unless there are extenuating circumstances.
INFORMATION ON OUR APPLICATION PROCESS CAN BE FOUND AT OUR WEBSITE:
WWW.KCHA.ORG
OR BY CONTACTING ANY KCHA MANAGEMENT OFFICE
INFORMATION ABOUT OUR PROPERTIES CAN BE FOUND AT:
WWW.KCHA.ORG/LOOKINGFORHOUSING/MASTERLIST.ASPX
Please remember to only select properties listed on the back page of this application.
THINGS TO KNOW:
1.
Prior to being offered a unit each applicant will be screened for tenant suitability. This screening consists of, but is not limited to, a criminal background check (including drug-related criminal activity), credit check, and a landlord history screening.
2.
Disability Status / Right To Reasonable Accommodation (Does not apply to Project Based Properties)
IF YOU HAVE A DISABILITY as outlined under Section 504 of the Americans With Disabilities Act or State or Local Fair Housing Laws, and require an accommodation that would allow you to live and use your apartment or access facilities in a manner equal to that of a non-disabled tenant, you may qualify for a Reasonable Accommodation. For example if you need:
- *
- A structural change or repair in your apartment, or a special type of apartment;
- *
- A change or repair in some other part of the housing development; or Housing Authority facilities; or,
- *
- A change in our rules, policies, or how we do things (ie: how we communicate with you or give
you information), You may request a Reasonable Accommodation from your local Housing Authority representative, and they will direct you on how to proceed with the process.
KCHA 105 REV 07/10/08
Initial application instructions
Personal information (head of household)
The head of household's Social Security number will be used to identify your family's application in our Data Base. If the head of household does not have a Social Security number a random account number will be assigned.
Name and Address (head of household)
We must have a current mailing address to contact you at all times. If we are unable to contact you by mail, you may be removed from the Public Housing waiting list without further notice.
Occupancy Guidelines
In determining the proper bedroom size for each family, generally speaking, children of the opposite sex over the age of 4 may not be required to share a bedroom in most cases. Please carefully analyze your family composition and select a property or region with the appropriate bedroom size for your family.
| No. of Bedrooms | Number of persons | |
|---|---|---|
| Minimum | Maximum | |
| 1 | 1 | 2 |
| 2 | 2 | 4 |
| 3 | 3 | 6 |
| 4 | 4 | 8 |
| 5 | 7 | 10 |
Central Applications offers an auto attendant telephone number. You may leave a message and a Housing Authority representative will return your call. You may also visit the property management office nearest you for assistance. The property management offices are noted in the property list, page 4, of your application.
The Auto Attendant telephone number is 206-574-1248. Calls are returned within 24 hours of receipt.
Waitlist Selections
KCHA policy allows applicants to be on the Site-Based Waiting List or the Regional Waiting List. The Site-Based Waiting List, allows you to choose one (1) or two (2) specific properties from the list on page 4. These will be the specific properties you wish to live at, OR a Regional Waiting List, where you choose one (1) or two
(2) of our three regions you would like to live in. Important: if you choose the Regional Waiting list you are offered the first available unit anywhere with-in your selected region. Do not choose both Regional and Site-Based Waiting List.
Ethnicity and Race
The housing authority collects statistical data on ethnicity and race in accordance with federal regulations. This is for statistical purposes only.
List all members who will live with you (fill in all requested fields)
List everyone who will be living with you, including aides and any unborn children you are expecting.
Additional Housing Program
If you are interested in any of our additional housing programs, please complete only the programs for which your family composition qualifies for according to the instructions provided.
Current living situation: waitlist preferences
Please select any or all of the waitlist preferences listed on page two as they apply to your current situation.
Please note:
Incomplete or incorrect applications will be returned to the applicant. Complete applications will receive an acceptance letter within 2- 4 weeks.
KCHA 105 REV 07/10/08
INITIAL APPLICATION FOR HOUSING
MAIL COMPLETED APPLICATION TO:
CENTRAL APPLICATION PROCESSING CENTER 20126 BALLINGER WAY NE, PMB 151 * SHORELINE, WA 98155-1290
Or return to any KCHA Management Office
I. Applicant Information: Please Print NEATLY In Ink
LAST NAME FIRST NAME MIDDLE INITIAL
| MAILING ADDRESS | APT. NO. | CITY | STATE | ZIP | ||
|---|---|---|---|---|---|---|
| ( | ) | ( | ) | |||
| HOME PHONE | WORK / MESSAGE PHONE | |||||
PLEASE LIST ANY OTHER NAMES YOU MAY HAVE USED IN THE PAST
Primary Language:_______________________________
(MAIDEN NAME, ALIAS, ETC.): _____________________________________
Translation Services Needed: YES NO
II. Household Information:
- Please list ALL HOUSEHOLD MEMBERS who will be living in the assisted unit. List the Head of Household on line #1 (list additional Members on a separate page if more space is needed):
- Does anyone live with you who is not listed above or are you expecting a baby? YES NO If YES, please list the name(s) and explain:_______________________________________________________________
| MBR # | LAST NAME | FIRST NAME | MI | AGE | SEX | RELATION TO HEAD | BIRTH DATE | BIRTH PLACE | SOCIAL SECURITY # |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Head of Household | ||||||||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 |
III. Family Information: 1) FAMILY STATUS: Check all that apply:
2) RACE: Please check one of the following:
Head of Household or Spouse is age 62 over.
Caucasian African American Asian Hispanic
Head of Household or Spouse is Disabled or Handicapped
Native American/Eskimo Hawaiian/Pacific Islander
Other Family Member is Disabled or Handicapped
This information is requested to comply with Equal Opportunity requirements
and will not affect your application for housing assistance.
None of the Above
| 3) INCOME SOURCE(S): Please list ALL sources of income received by ALL adult members of your household: Examples: Wages, Pension, Child Support, SSI, SSA, L&I, TANF, and Regular Gifts. List additional income on a separate page if more space is needed | |||
|---|---|---|---|
| MBR# | Type of Income (wages, etc.) | Amount Received (circle one) | Hrs per wk (if applicable) |
| $ per hour week month | |||
| $ per hour week month | |||
| $ per hour week month | |||
| $ per hour week month | |||
| $ per hour week month | |||
III. Family Information (continued):
- Does anyone listed on your application have a Criminal Record? Answering YES, will not automatically exclude you from housing. A Criminal History background check will be run on you and your adult family members. YES NO
- If YES, please list any criminal history, which will appear on your records and where it occurred: __________________ _________________________________________________________________________________________
- Has anyone listed on the application served in the U.S. Armed Forces? YES NO
- Has anyone listed on your application previously lived in Public Housing? YES NO
- If YES, please list who, along with when and where they lived in Public Housing: _______________________________ _________________________________________________________________________________________
- Does your family require a handicapped-modified unit? (Examples: roll-in shower, wheelchair accessible, etc.) YES NO
- Does any family member require a reasonable accommodation? (Example: live-in aid, etc.)
YES NO If YES, please complete a Reasonable Accommodation form, available from any KCHA office.
IV. Preferences:
Extremely Low Income Preference
1) Do you currently live in subsidized housing or receive a government rent subsidy? YES NO
- If you answered “YES” you do not qualify for the Extremely Low Income preference. Go to Question 3.
- •
- If you answered “NO”, go to question 2.
2) Is your yearly income at or below the limits given for your family size on the chart below? YES NO
| Family Size | Annual Income | Family Size | Annual Income | Family Size | Annual Income | Family Size | Annual Income | Family Size | Annual Income | Family Size | Annual Income |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | $17,700 | 3 | $22,750 | 5 | $27,300 | 7 | $31,350 | 9 | $35,400 | 11 | $39,450 |
| 2 | $20,250 | 4 | $25,300 | 6 | $29,350 | 8 | $33,400 | 10 | $37,450 |
- If you answered, “YES”, you appear to qualify for the “Extremely Low Income” preference continue onto Question 3.
- If you answered, “NO”, you may still qualify for one of KCHA’s other preferences, continue onto Question 3.
Substandard Housing, Displaced, and Rent Burden Preferences 3 a) Are you currently homeless, live in a dilapidated home or live in a home without one of the following: plumbing, toilet, tub/shower, kitchen, electricity, or heat? YES NO b) Are you currently displaced from your home by natural disaster, government action, domestic violence, or forced to move to avoid reprisal, due to hate crimes, owner action, or unit inaccessibility? YES NO c) Have you been paying more than 50% of your Gross Income (income before taxes are taken out) for rent and utilities for the last 90 days? Utilities do not include phone or cable. YES NO
• If you answered “YES” to any of the above questions (3a-c), you appear to qualify for a preference.
PLEASE NOTE: All preferences will be verified prior to an offer of housing.
• If you did not answer “YES”, to any of the above questions then you do not appear to qualify for a preference at this time and will be placed on our waiting list as a non-preference.
V. Wait List Choice: KCHA allows applicants to select the type of waiting list they would like to be on. You may be on either a Site-Based Waiting List, where you choose which of our properties (listed on back) you would like to live in, OR a Regional Waiting List, where you choose which of our three regions you would like to live in and are offered the first available unit anywhere in that region. With both lists, you have up to two choices.
Please place my application on the waiting list indicated: CHOOSE ONLY A or B
OR
Regional Waiting Lists: Using the list on the back of this page select up to two (2) regions and write their
B
name(s) on the lines below. You will be offered the first available unit of appropriate size that becomes available in that region. Regions are large areas within King County and you must be more flexible about where you will live. You must take the first unit offered to you or risk cancellation of your application.
- ______________________________
- ______________________________
VI. Signature:
I hereby certify that the information provided in this application is true to the best of my knowledge and belief. I understand that any false statements made on this application may result in the cancellation of my application and if housed, my family will be subject to eviction. I also understand I must report any changes in the above information to the housing office in writing. Failure to report accurate information with regards to my family circumstances and any changes that may occur, may result in delays in the application process and could ultimately lead to cancellation of my application, without further notice. I certify that I have read and understand this declaration and I understand that I will be required to successfully complete a criminal background check, a credit history check, provide landlord history for the past three years and update my local preference and income status, which will be verified by the Housing Authority before a final determination regarding the suitability of my application will be made. Failure to respond to any correspondence from the Housing Authority may result in delays in the application process and could ultimately lead to cancellation of my application without further notice.
Head of Household Signature______________________________________________ Date______________
Please see the back of this sheet for information about our properties and regions. For detailed information about the properties, please see our website at: http://www.kcha.org, or any KCHA office
KING COUNTY HOUSING AUTHORITY PUBLIC HOUSING PROPERTIES
| NORTH / EAST REGION | ||||||
|---|---|---|---|---|---|---|
| Properties | Studio | 1 Bdrm | 2 Bdrm | 3 Bdrm | 4 Bdrm | 5 Bdrm |
| Paramount House 1750 NE 145th, Shoreline 98155~70 Units Northridge I 1540 NE 177th, Shoreline 98155~70 Units (NON-SMOKING) √ Briarwood 18026 Midvale Ave N, Shoreline 98133~70 UnitsCasa Juanita 9821 NE 122nd St, Kirkland 98034~80 UnitsEastridge House 120 Sunset Way W, Issaquah 98027~40 UnitsForest Glen 8610 164th NE, Redmond 98052~40 UnitsLake House 1313 N 200th, Shoreline 98133~70 Units√ Northridge II 1530 NE 177th, Shoreline 98155~70 Units√ Ballinger Homes 2200 NE 201st Pl, Shoreline 98155~110 Units Eastside Terrace 704 147th Pl NE, Bellevue 98007~50 UnitsAvondale Manor 17107 NE 80th St, Redmond 98052~20 Units Cedarwood 14415 123rd Ln NE, Kirkland 98034~25 Units√ College Place 1249 145th Pl SE, Bellevue 98007~51 UnitsForest Grove 8350 167th Ave NE, Redmond 98052~25 UnitsGreen Leaf 16714 68th Ave NE, Kenmore 98028~27 Units√ Juanita Court 9926 NE 126th St, Kirkland 98034~30 Units√ Juanita Trace I and II 13137 107th Pl NE, Kirkland 98034~39 UnitsKirkwood Terrace 11925 NE 81st Circle, Kirkland 98033~28 UnitsWells Wood 18100 142nd Ave NE, Woodinville 98072~30 UnitsBellevue Houses Various Addresses, Bellevue ~8 Units ª | 42** | 27** | ||||
| 42** | 27** | |||||
| 70** | ||||||
| 80** | ||||||
| 39** | ||||||
| 39** | ||||||
| 69** | ||||||
| 69** | ||||||
| 10 | 38 | 41 | 14 | 6 | ||
| 8 | 32 | 10 | ||||
| 4 | 10 | 6 | ||||
| 22 | 3 | |||||
| 37 | 14 | |||||
| 18 | 7 | |||||
| 22 | 5 | |||||
| 25 | 5 | |||||
| 29 | 10 | |||||
| 22 | 6 | |||||
| 25 | 5 | |||||
| 8 | ||||||
| SOUTHWEST REGION | ||||||
| Properties | Studio | 1 Bdrm | 2 Bdrm | 3 Bdrm | 4 Bdrm | 5 Bdrm |
| Brittany Park 18265 1st Ave S, Normandy Park 98148~43 Units √ Boulevard Manor 12039 Roseberg Ave S, Seattle 98168~70 UnitsMunro Manor 630 S 152nd, Burien 98168~60 Units Nia 815 SW 99th St, Seattle 98106~82 Units (SMOKE-FREE)√ Southridge House 30838 14th Ave S, Federal Way 98003~80 UnitsYardley Arms 1000 SW 130th St, Seattle 98146~67 Units√ Riverton Terrace 14440 41st Ave S, Tukwila 98168~60 Units Greenbridge 9839 8th Ave. SW, Seattle 98106~366 Units √ Evergreen Court 33014 19th Ln S, Federal Way 98003~30 UnitsKings Court 333rd & 22nd Ln. S, Federal Way 98003~30 UnitsFederal Way Houses Various Addresses, Federal Way ~3 Units ‡Campus Court 24510 26th Pl S, Des Moines 98198~12 UnitsShoreham Apts. 22815 30th Ave S, Des Moines 98198~18 UnitsVictorian Woods 22418 30th Ave S, Des Moines 98198~15 Units | 43** | |||||
| 70** | ||||||
| 60** | ||||||
| 65** | 17** | |||||
| 80** | ||||||
| 67** | ||||||
| 30** | 18 | 5 | 5 | 2 | ||
| 62 | 203 | 85 | 13 | 3 | ||
| 22 | 8 | |||||
| 21 | 9 | |||||
| 3 | ||||||
| 12 | ||||||
| 18 | ||||||
| 15 | ||||||
| SOUTHEAST REGION | ||||||
| Properties | Studio | 1 Bdrm | 2 Bdrm | 3 Bdrm | 4 Bdrm | 5 Bdrm |
| Gustaves Manor 107 W Main St, Auburn 98001~35 Units Wayland Arms 307 S Division, Auburn 98001~67 Units Mardi Gras 24009 104th Ave SE, Kent 98030~61 Units Plaza Seventeen 1001 17th St SE, Auburn 98002~70 Units (NON-SMOKING) √ Birch Creek 27360 129th Pl SE, Kent 98030~262 Units √ Burndale Homes 930 18th Pl NE, Auburn 98002~50 Units √ Cascade Apts 20500 106th Ave SE, Kent 98031~108 Units√ Firwood Circle 313 37th St SE, Auburn 98002~50 Units√ Green River Homes 1103 9th St SE, Auburn 98002~60 Units√ Valli Kee Homes 23401 104th Ave SE, Kent 98031~114 Units Glenview Heights 10405 SE 172nd, Renton 98055~10 UnitsYoungs Lake 18923 115th Ln SE, Renton 98055~28 Units ‡Vista Heights 18415-8419 108th Ave SE, Renton 98055~30 Units ‡Campus Court II 716 S 3rd St, Kent 98032~1 Unit | 4** | 31** | ||||
| 39** | 27** | |||||
| 60** | ||||||
| 3** | 66** | |||||
| 5 | 95 | 123 | 36 | 3 | ||
| 3 | 16 | 21 | 8 | 2 | ||
| 8 | 52 | 48 | ||||
| 4 | 16 | 20 | 8 | 2 | ||
| 8 | 30 | 18 | 4 | |||
| 18 | 26 | 50 | 20 | |||
| 6 | 4 | |||||
| 4 | 24 | |||||
| 30 | ||||||
| 1 | ||||||
| SITE BASED LISTS ONLY | ||||||
| Properties | Studio | 1 Bdrm | 2 Bdrm | 3 Bdrm | 4 Bdrm | 5 Bdrm |
| √ Casa Madrona 3948 Martin Way E, Olympia 98506~70 Units Pickering Court 7800 Pickering Crt SE, Snoqualmie 98065~30 Units | 69** | |||||
| 4 | 17 | 9 | ||||
√ Locations with KCHA Management Offices ** Preference for seniors and the disabled ª Preference for homeless families
‡ Preference for current KCHA tenants Building participates in the Low Income Housing Tax Credit program. Additional restrictions may apply.
~PLEASE NOTE: Choosing a Regional List will place you in the first available apartment in the region when your name comes to the top of the waiting list. Each region contains several cities so you may be offered an apartment in any one of the buildings in any one of the cities.
KING COUNTY HOUSING AUTHORITY
CENTRAL APPLICATION PROCESSING CENTER
20126 BALLINGER WAY NE, PMB 151 * SHORELINE, WA 98155-1290 PHONE (206) 574-1248 FAX (206) 574-1241
The Programs listed below are separate from Public Housing. Each program has its own requirements. You may apply for as many of these programs as you qualify for. Being on these waiting lists will NOT affect your status on the Public Housing waiting list.
SECTION 8 NEW CONSTRUCTION (Elderly (62+) Households may apply) - 1 bd units only You may check as many properties as you are interested in:
For questions about these properties, please contact the management office at the number listed below.
Burien Park: 500 SW 148th Street, Burien, WA 98166 Telephone #: (206) 957-1069 The Northwood: 18128 73rd NE, Kenmore, WA 98028 Telephone: #: (206) 574-1226 Northlake House: 18219 96th NE, Bothell, WA 98011 Telephone #: (206) 574-1226
LOCAL PROGRAMS
(Elderly (60+) Households may apply) - 1 bd units only Flat rent of $330 per month You may check as many properties as you are interested in, however, you must have income to support the rent of $330 per month.
Campus Green: 501 S 320th Street, Federal Way, WA 98003 Echo Cove: 19428 Aurora Avenue N, Shoreline, WA 98133 Harbour Villa: 7217 NE 175th Street, Kenmore, WA 98028 Slater Park: 12604 NE 119th Street, Kirkland, WA 98033
PRESERVATION PROGRAM The properties listed below require a SEPARATE APPLICATION. Please contact the Preservation Program at 206-315-4380 for more information.
Hidden Village: 14508 SE 24th Street, Bellevue, WA 98007 - 1, 2, 3, and 4 bd units Newport Apartments: 12646 SE 42nd Street, Bellevue, WA 98006 - 1, 2, and 3 bd units Parkway Apartments: 3970 W Lake Sammamish Parkway NE, Redmond, WA 98052 - 1, 2, and 3 bd units Spiritwood Manor: 1424 148th Avenue SE, Bellevue, WA 98007 - 1, 2, and 3 bd units
IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT ANY KCHA MANAGEMENT OFFICE. (OVER)
KCHA 236 5/15/08
SUBSIDIZED PRIVATE HOUSING
King County Housing Authority contracts with Private Landlords to subsidize a limited number of units for which you can apply. These units are found in various private apartment complexes around the region. You may apply for this program along with the Public Housing Program. Rent is based on household income.
The private management company screens applicants for these units. There is often a screening fee for each adult household member.
More information about these developments is available at the KCHA property management office. Please ask to see the "Private Housing Binder" for a description of the properties. You may also find additional information at our web site, www.kcha.org
1. Private Housing Wait List Options
A. Any Unit in the North/East Region of King County. (Primarily 2, 3, & 4 bedroom units)
Locations may include, but are not limited to: Bellevue, Kirkland, Issaquah, and Lake Forest Park. You will be offered the first available unit of appropriate size that becomes available in this region.
B. Laurelwood Apartments located in Federal Way. (3 & 4 bedroom units only)
C. Eernisse Apartments located on Vashon Island. (Primarily 2 & 3 bedroom units)
* This housing is on an island and requires ferry transportation to and from Seattle. Ferry prices are at least $14.40 per round trip for a vehicle and $4.20 per passenger. There are limited employment opportunities on the island, and residents who work off the island have a round-trip commute which averages 3 hours each day. Please carefully consider choosing this option .
Using the list above, select up to two (2) options and write them on the lines below. Be sure that the lists that you choose have the bedroom size that meets your need.
- ________________________________________
- ________________________________________
2. Head of Household Information PLEASE PRINT:
I understand that if I am not eligible for a list I have chosen, I will not be added to that list. I understand that I am required to update the information on my initial application with KCHA if any of this information changes.
LAST FIRST NAME: NAME:
SOCIAL SECURITY #:
KCHA Staff Use Only: Bedroom Size: Private Housing Application Date: Time:
KCHA 236 5/15/08
KING COUNTY HOUSING AUTHORITY
CENTRAL APPLICATION PROCESSING CENTER
20126 Ballinger Way NE, PMB 151, Shoreline WA 98155-1290 PHONE (206) 574-1248 FAX (206) 574-1241
ANNOUNCEMENT
The King County Housing Authority is pleased to announce we now have two ways to gather information about out waiting lists.
The Web Tool:
The Waiting List Lookup tool is now available on our web site, www.kcha.org. It can be located by clicking on “Looking For Housing” and then “Subsidized Housing”. You will be taken through a few steps to choose the area or property and bedroom size you are interested in. This will then provide you the date of the application at the top of the waiting list. From this information, you can gauge how long the wait might be. Below is an example of what you will see:
STEP 1: Please select a Property or Regional waiting list name:
STEP 2: Please select a bedroom size:
*
Next application date to be housed:
10/3/2003
Automated Telephone Line
The Automated Telephone Line works much like the Wait List Lookup tool. You dial the Central Applications telephone number, (206)574-1248, Press 4, then follow the menu items, selecting the Region and bedroom size you are interested in. The auto attendant will then list the date of the application at the top of the waiting list for the properties with the bedroom size you selected within the region you chose. If at any time you wish to start over, you will need to hang up and dial the telephone number again, press “4” again to select a different region or bedroom size. The automated telephone line is updated quarterly.
If you have questions about either of these tools, please contact the property management office nearest you for assistance.
KCHA 300 Rev 3/19/07
