Public Housing Pre Application – The Housing Authority of Covington

1Your Information

2Your Family

3Your Address

4Your Income

5Your Assets

6General Questions

7Done

Tell Us About The Head Of Household

(You’ll add your family members later)
Your Name
First Middle Last
Gender
SelectMaleFemale
Social Security Number
Birth Date
MM slash DD slash YYYY
Race(s) (select all that apply)
WhiteBlack/African AmericanThird American Indian/Alaska NativeChoiceAsianNative Hawaiian/Other Pacific Islander
Ethnicity
Select OneHispanic or LatinoNot Hispanic or Latino
Are you a U.S. Veteran?
Select OneYesNo
Are you disabled?
Select OneYesNo
Phone Number
Email
Best method to contact you
PhoneEmail
ALL WAITING LISTS ARE CLOSED AND NO APPLICATIONS ARE BEING ACCEPTED UNTIL FURTHER NOTICE.
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Golden Tower
- Golden Tower (Senior Community) – 50E 11th Street, Covington KY 41011
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New Site Properties
- NSP (New Site Properties) 2-3 Bedroom
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City Heights
- City Heights- 2500 Todd Street, Covington, KY 41011

Tell Us About Your Family

Provide information for the individuals who will live with you in your household.
How many family members (NOT including yourself) will be on this application?
0123456789

Tell Us About Your Family Members

<tbody data-bind="visible: entries().length <tr class="gpnf-no-entries" data-bind="visible: entries().length

Name	Gender	Relationship to Head Of Household	Social Security Number	Birth Date	Race(s) (select all that apply)	Ethnicity	Family member is a U.S. Veteran	Family member is disabled.	Actions

There are no Entries.

Maximum number of entries reached.

Provide information for the individuals who will live with you in your household.

Tell Us About Your Address…
Street
Suite/Apt
City
State
Zip Code

Tell Us About Your Family’s Income…

Please include income from all family members

Add Income for each Family Member

<tbody data-bind="visible: entries().length <tr class="gpnf-no-entries" data-bind="visible: entries().length

Whose income is it?	Type of Income	Who do you receive it from?	How much do you receive? (Gross Amount)	How often do you receive it?	Actions

There are no Entries.

Maximum number of entries reached.

Tell Us About Your Family’s Assets…

Please include assets from all family members

Add assets for all Family Members

<tbody data-bind="visible: entries().length <tr class="gpnf-no-entries" data-bind="visible: entries().length

Whose asset is it?	Type of Asset?	Description/Source (Name of Bank, Name of Insurance Company, Location of Real Estate, etc.)	What is it worth? (Amount)	Actions

There are no Entries.

Maximum number of entries reached.

Answer Question(s) Below:

Please answer all questions
a. Have you or anyone in your home ever been subject to sex offender registration?
- Yes
- No
b. Have you or anyone in your home ever been arrested, or convicted of a felony or misdemeanor?
- Yes
- No
If yes, explain including year and state:
c. Have you or anyone in your household ever been arrested, charged with possession, manufacturing or selling illegal drugs or other controlled substances?
- Yes
- No
If yes, explain including year & state:
d. Does anyone outside of your household pay for any of your bills or give you money on a monthly basis?
- Yes
- No
If yes, who:
For:
Monthly Amount $
e. Do you live or work in Covington?
- Yes
- No
f. Do you work 35 hours or more and have been doing so for (1) year, 62 years of age or older, or people with disabilities?
- Yes
- No
g. Do you work 20 hours or more and have been doing so for 180 days, 62 years of age or older, or people with disabilities?
- Yes
- No
h. Are you a homeless veteran?
- Yes
- No
i. Have you been a victim of domestic violence, reprisals or hate crimes?
- Yes
- No
j. Have you been displaced by government action or whose dwelling has been extensively damaged or destroyed as a result of a disaster declared or otherwise formally recognized pursuant to Federal Disaster Relief Laws?
- Yes
- No
k. Do you suffer from a High Rent Burden?
- Yes
- No

What You’ve Told Us…
Consent * Required
Verify that all the information i provided is correct
Type your Signature * Required
Housing Authority of Covington staff will contact you.

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Applicants will choose a studio, one-, two-, or three-bedroom preference based on needs. Applications are available on the HOME page of our website or pick up and application at 2300 Madison Ave., Covington, KY 41014, during normal business hours, Monday – Friday from 8:00am – 4:30pm.

SUBMIT YOUR APPLICATIONS TO leasing@hacov.org

info@hacov.wfcstaging.com

859-491-5311

info@hacov.org

859-491-5311

Tell Us About The Head Of Household

(You’ll add your family members later)

ALL WAITING LISTS ARE CLOSED AND NO APPLICATIONS ARE BEING ACCEPTED UNTIL FURTHER NOTICE.

Tell Us About Your Family

Provide information for the individuals who will live with you in your household.

Tell Us About Your Address…

Tell Us About Your Family’s Income…

Please include income from all family members

Tell Us About Your Family’s Assets…

Please include assets from all family members

Answer Question(s) Below:

Please answer all questions

What You’ve Told Us…

Housing Authority of Covington staff will contact you.

Our Information

Get in touch