Bridges Application

Bridges Application

This application is for the Bridges Program only. Read the instructions for each section and answer all required questions. Incomplete applications will slow processing and may be returned. Once completed, please give this form to your local Housing Agency. Do not send it to Minnesota Housing.

Housing Choice Voucher Requirement

To receive Bridges rental assistance, you must also apply for a Section 8 Housing Choice Voucher. If the waiting list is currently closed, you must apply as soon as the waiting list opens and provide evidence of your application. Failure to do so will result in termination from the Bridges program, and you will no longer receive a rent subsidy.

Have you applied for a Section 8 Housing Choice Voucher?










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Personal Information


Extent of homelessness prior to program intake:

Living situation prior to program intake:

Emergency Contact


Case Manager (if applicable)



Crisis Assistance Organization

Household Information

Marital Status:

List the head of household and all other individual(s) who will be residing in the unit. Include the relationship of each family member to the head of household.





































You are not required to provide race and ethnicity information, but supplying it will help with monitoring and determining compliance with civil rights laws.

Race of Head of Household

Race of Head of Household

Income Information

Include income for all household members age 18 and over. Income eligibility will be recertified annually.
You are responsible for immediately notifying your local Housing Agency, in writing, if your income changes at any time while receiving assistance.

For each YES above, provide income details below. Add additional pages, if necessary, as well as the name and address of employers. Be sure to list gross income (pre-tax income) for wages, Social Security and Medicare.













Total

Employment







Assets

All household members’ assets must be included below.

















You may be required to provide evidence of income and assets including:
  • Benefit award letters from Social Security, MSA, GA, etc.
  • Payroll check stubs showing hours worked and rate of pay (provide, at a minimum, one month)
  • Copy of a recent bank statement showing the account balance and interest rate
  • Any other documentation of income and assets that may be available

Applicant Certification

The application must be filled out completely and signed by the applicant and all other adults 18 or older living in the household.

With my signature below, I verify that: