Phone:       (772) 567-6182
Fax:            (772) 567-6129
TTY:            (800) 955-8771
E-Mail:        [email protected]
Days:          Tuesdays and Thursdays (Appointments Preferred)
Hours:        10:00am to 2:00pm
Fee:            $25 per adult

INFORMATION TO INCLUDE WITH COMPLETED APPLICATION

FOR PERSONAL IDENTIFICATION:

1. Social Security cards and birth certificates for each member in the household

2. Photo ID for each adult family member (18 & older)

EMPLOYMENT INFORMATION:

1. Name, address, zip code, phone and fax number of Employer
2. Hourly, weekly or monthly amount earned

VERIFICATION OF OTHER SOURCES OF INCOME:

Veteran’s Pension
Retirement Pension
Alimony
Child Support (last 12 months)
Unemployment Benefits
Workman’s Compensation
Public Assistance (Most recent award letter)
Checking/Savings Interest, Etc. (Last 6 months bank statements)
Social Security & SSI (Most recent award letter)

VERIFICATION OF ALL ASSETS FOR HOUSEHOLD

401K
Stocks
Bonds
Annuities
Whole life insurance policies

VERIFICATION OF EXPENSES

Child Care (Provider information)
Medical Expenses (Pharmacy information)

RESIDENTIAL HISTORY:

Current Landlord, Mortgage Company and\or Past Landlord(s) for the last three years:

Full Name
Contact Person
Street, City, State & Zip Code
Phone Number