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ACRA - Durham
1017 Cook Rd
Durham, NC 27713

Application for Housing Assistance

Note: This is a preliminary application. For your security, please DO NOT submit copies of your Social Security Card or Photo ID through this website. We will request those documents securely at a later stage in the application process.

Applicant Information
1. Household Composition

Please list each person who would occupy the premise with you:

Last Name
First Name
D.O.B.
Gender
Relationship
Income Source(s)
Housing Questionnaire
Yes No
Yes No
Active Reserved Veteran
Yes No
Yes No
One Two Three
Mobility Visual Audio
Select Sources (Click to expand)

Please check all that apply to your household:

Certification & Signature

Confidentiality Statement: All information provided in this application is strictly confidential and will be used solely for the purpose of determining eligibility for housing assistance.

Application Process: This is a preliminary application. After review, you will be contacted to schedule an interview where you will be required to provide formal identification (Picture ID) and Social Security Cards.