City Of Tucson
Public Housing Program
Application Form

Community Services Department
City of Tucson
(520) 791-4616

Your Name :

Mailing Address :

Phone home or message number

Social Security No.  -   - 
Pursuant to the code of Federal regulations: Social Security numbers of household members are mandatory.

Family Composition:

Name Age Date of Birth Relationship to you Sex
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Yearly gross income of the household: $

Number of people in the household:

Is the head of household or the spouse elderly (62 years or more)?:

Is the head of household or the spouse disabled?:

Race and ethnicity description for the head of household.
Race :
Ethnicity :

  • All information given on this form is confidential and will not be released to anyone without your written consent.
  • Final eligibility will be determined before housing assistance is available for you.
  • All adult family members will be screened for tenancy considering information provided through landlord references, credit reports and criminal background investigations.

I certify that I have provided accurate and complete information regarding family composition, to the best of my knowledge and belief. I understand that providing false statements and/or information is punishable under federal law and is grounds for denial of program assistance or termination of tenancy.

If you should require an accommodation or alternative arrangements due to a disability, please call (520) 791-4616.

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