Head of Household, Please Choose One Option Below That Best Describes Your Household

Applicant - Resident Student Eligibility Certification

In order to be deemed eligible for Section 8 Assistance, a student attending an “institution of higher learning” for the purpose of obtaining a degree, certificate, or other program leading to a recognized educational credential must meet all screening criteria and a program exception. All exceptions must be verifiable.

Head of Household, please choose one option below that best describes your household.

My household does not contain any students 18 or older who are enrolled in an institute of higher learning.
My household does contain students 18 or older who are enrolled in an institute of higher learning.If you check this box, you must answer the questions below.

Yes No

My household has a student(s) living with the parent or guardian applying for or receiving section 8.
My household has a student(s) who is at least 24 years of age.
My household has a student(s) who is a Veteran of United States Military.
My household has a student(s) who is married.
My household has a student(s) who has a dependent child.
My household has a student (s) with disabilities as defined in 3(b)(3)(E) of the United States Housing Act of 1937 (42 U.S.C 1437a(b)(3)(E)) and was receiving assistance under such Section 8 as of November 30,2005
My household has a student(s) who is considered an Independent Student.
a. The individual is 24 years of age or older by December 31 of the award year;
b. The individual is an orphan, in foster care, or a ward of the court or was an orphan, in foster care, or a ward of the court at any time when the individual was 13 years of age of older;
c. The individual is, or was immediately prior to attaining the age of majority, an emancipated minor or in legal guardianship as determined by a court of competent jurisdiction in the individual's State of legal residence;
d. The individual is a veteran of the Armed Forces of the United States (as defined in subsection (c)(1) of HEA) or is currently serving on active duty in
the Armed Forces for other than training purposes
e. The individual is a graduate or professional student;
f. The individual is a married individual;
g. The individual has legal dependents other than a spouse;
h. The individual has been verified during the school year in which the application is submitted as either an unaccompanied youth who is a homeless child or youth (as such terms are defined in section 725 of the McKinney-VentoHomeless Assistance Act) (42 U.S.C. 11431 et seq.), or as unaccompanied, at risk of homelessness, and self-supporting, by
(i) a local educational agency homeless liaison, designated pursuant to section 722(g)(1)(J) (ii) of the McKinney-Vento Homeless Assistance Act;
(ii) the director of a program funded under the Runaway and Homeless Youth Act or a designee of the director;
(iii) the director of a program funded under subtitle B of title IV of the McKinney-Vento Homeless Assistance Act (relating to emergency shelter
grants) or a designee of the director; or
(iv) a financial aid administrator; or
i. The individual is a student for whom a financial aid administrator makes a documented determination of independence by reason of other unusual circumstances.[2]
My household has a student(s) whose parents are income eligible for the Section 8 program

Name of Student(s):

Name, address and telephone number of school:

Under penalties of perjury, I/we certify that the information presented in this certification is true and accurate to the best of my/our knowledge and belief. I/we agree to notify management immediately of any changes in this household’s student status. I/we understand that providing false, misleading, or incomplete information may result in the termination of the lease agreement.

Head of householdDateCo-headDate

Other member 18 or olderDateOther member 18 or olderDate

Students include individuals attending public or private elementary schools, middle or junior high schools, senior high schools, colleges, universities, technical, trade or mechanical schools. Students do not include individuals participated in on-the-job training or correspondence courses.

Head of Household, please choose one option below that best describes your household.

1. My household does not contain any occupants who are students (full or part time)
2. My household contains at least one member who is not a student and will not be a student for five months or
more out of the current calendar year or the calendar year preceding the certification date. (months need
not be consecutive)List Non-Student here:
3. My household contains all students, but is qualified because at least one student is part time. (must be
Verifiable). List part-time student(s) here: ______
4. My household contains all full time students for five months or more out of the current and/or upcoming calendar year. (Months need not be consecutive). If you check this box, you must answer the questions below.

YES NO

Are the students married and entitled to file a joint tax return? (attach an affidavit or tax return)
Is at least one student a single parent with child(ren), and this parent is not a dependent of someone else, and the child(ren) is/are not dependent(s) of someone other than the parent(s)?
Is at least one student receiving Temporary Assistance to Needy Families (TANF)?
Does at least one student participate in a program receiving assistance under the Job Training Partnership Act, Workforce Investment Act, or under other similar federal, state, or local laws? (attach verification of participation)
Does the household consist of at least one student who was previously under foster care? (provide verification of participation)

If you selected an option other than 1above, please provide information below.

Name of Student(s):

Name, address and telephone number of school:

Name of Student(s):

Name, address and telephone number of school:

Head of householdDateCo-headDate

Other member 18 or olderDateOther member 18 or olderDate

Applicant-Resident Student Eligibility Certification 101116