Section 3 Resident Self-Certification and Skills/Data Collection Forms
The purpose of this form is to comply with HUD Section 3 administration and certification regulations.
Print Name *
Your answer
My home address is (must be a street address and NOT a P.O. Box number): *
Your answer
Phone Number
Your answer
Email Address *
Your answer
To qualify as a Section 3 Resident, you must meet one of the following standards:
1. Be a public housing resident or a Housing Choice Voucher program participant (Section 8 rent assistance voucher) managed by ARHA ; OR

2. Be a low income or very low income person who resides in the City of Alexandria and whose total household income does not exceed the following amounts:
Check One *
Required
Check All That Apply
Please list degree(s) or certifications
Your answer
Check the Skills Trades and/or Professions you have been employed in or contracted to do for others: *
Required
I hereby certify to the U.S. Department of Housing and Urban Development (HUD) and to Alexandria Redevelopment & Housing Authority that all of the information on this form is true and correct. I attest under penalty of perjury that my total household income and household size is as shown above, and that proof of this information may be requested in the future. If found to be inaccurate, I understand that I may be disqualified as an applicant and/or a certified Section 3 individual which may be grounds for termination of training, employment, or contracts that resulted from this certification. I also understand that failure to complete this form completely and accurately may result in other administrative remedies available to HUD. Finally, I authorize ARHA to include my name on a list of Section 3 Residents seeking employment and to include my contact information so that contractors may contact me.
Signature *
Your answer
Date *
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