Preliminary Application Step 1 of 3 – Applicant 33% Applicant InformationDateTimeDate and TimePreferred Housing CommunitySelect a Housing CommunityArchbishop Hurley HallSt. Joseph ManorSt. Mary TowersThis field is hidden when viewing the formSelected CommunityThis field is hidden when viewing the formSelected Community ID Waitlist TypeWe cannot guarantee availability of specific unit types, but we take into account your unit preference as well as your ADA needs. At this time this housing community is offering units Preferred Unit Type Please indicate your preference belowStudio(Required)Select PreferenceFirst ChoiceSecond ChoiceNot InterestedOne Bedroom(Required)Select PreferenceFirst ChoiceSecond ChoiceNot InterestedOne Bedroom(Required)Select PreferenceFirst ChoiceNot InterestedThis field is hidden when viewing the formStudio not offeredDo you require the ADA accessibility features of the following types of units(Required) Mobility Hearing Vision None This field is hidden when viewing the formfirstchoiceThis field is hidden when viewing the formsecondchoice This field is hidden when viewing the formPreferred Housing Community AllSelect a Housing CommunityArchbishop Carroll ManorArchbishop Hurley HallArchbishop McCarthy ResidenceCasa Sant’AngeloMarian TowersPalmer HouseSt. Andrew Towers ISt. Andrew Towers IISt. Anne’s GardensSt. Boniface GardensSt. Dominic GardensSt. Elizabeth GardensSt. Joseph ManorSt. Joseph Manor IISt. Joseph TowersSt. Mary TowersSt. Monica GardensSt. Vincent De Paul GardensStella Maris HouseThis field is hidden when viewing the formCommunity AddressThis field is hidden when viewing the formCommunity PhoneThis field is hidden when viewing the formCommunity Phone2Name(Required) First Last Address(Required)Address Line 2City(Required)State(Required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP Code(Required)Do you work in the City of Pompano Beach? Yes No Social Security Number(Required)Date of Birth(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home PhoneCell PhoneFriend/Relative PhoneThis field is hidden when viewing the formFormatted DOBU.S. Citizen(Required) Yes No Legal Alien(Required) Yes No Ethnicity Hispanic Non-Hispanic I choose not to participate Race White Black American Indian/Alaskan Native Asian/Pacific Islander I choose not to participate Is there anyone in the household who is a student?(Required) Yes No Is there a co-applicant?(Required) Yes No Do you have a Section 8 Voucher or other housing assistance?(Required) Yes No Co-applicantCo-Applicant Name(Required) First Last Relationship to Applicant(Required) Spouse Other Co-applicant Social Security(Required)Co-applicant Date of Birth(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Co-applicant Ethnicity Hispanic Non-Hispanic Co-applicant Race White Black American Indian/Alaskan Native Asian/Pacific Islander IncomeTotal gross household income (Combined for all members) Please enter 0 if you do not have income in types specified below.Income from Social Security(Required)social Security Month/Annual(Required) Monthly Annually Income from Pensions(Required)Pension Month/Annual(Required) Monthly Annually Income from Work & Other(Required)Income Other Month/Annual(Required) Monthly Annually AssetsSavings Account Yes No Checking Account Yes No Bonds Yes No Other Yes No Any false or withheld information is considered fraud and may be considered grounds for rejection of your application or eviction.By entering your name in the signature field, you are digitally signing this form.Applicant SignatureSignature Date 07/13/2026This field is hidden when viewing the formApplicant Date SignedCo-applicant SignatureSignature Date 07/13/2026This field is hidden when viewing the formCo-applicant Date Signed
