Making Moves Interest Form

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The Making Moves provides housing mobility coaching and financial assistance to Housing Choice Voucher (Section 8) families that have children age 18 or under who are interested in

well resourced areas.

Are you a current Housing Choice Voucher (Section 8) participant with CDLI or another local housing authority in Nassau or Suffolk County?

YesNo

What agency administers your voucher?

CDLIOther

If other, what agency administers your voucher?

To be eligible for this opportunity you must currently be receiving housing voucher assistance.

First Name

Last Name

Date of Birth

Are you the Head of Household?

Relationship to Head of Household

Home Phone

Cell Phone

Preferred Phone

What is the best way to reach you?

Would you like to receive monthly email updates and information from us?

Street Address

City

State

Postal Code

Demographic Information

What is your marital status?

What is your gender?

What is your race?

What is your ethnicity?

Does someone in your family have a disability?

Voucher Details

Log Number

Date Issued

Expiration Date

What town or county is your voucher issued with?

What is your current Housing Choice Voucher (Section 8) status?

Voucher Bedroom size

Number of People in Household

Household Composition
Please enter information below for ALL persons who will live in your home

Child Information - Minors (under 18)

First Name

Last Name

Date of Birth

School Name

School District

School Street Address

City

State

Postal Code

Household Member Information - Adults (18+)

First Name

Last Name

Date of Birth

Is Head of Household?

Relationship to Head of Household

In school or working? Select all that apply.

In schoolWorking

How were you referred to /hear about the Making Moves program?

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