ACRA - Durham
1017 Cook Rd
Durham, NC 27713

Application for Housing Assistance

Step 1: Pre-Qualification Check

Why are we asking this? We want to help pre-qualify your eligibility before you spend time completing the full application. ACRA housing is specifically targeted for elderly or disabled individuals, with capacity limits based on unit size.

What happens to this data? We do not save your pre-qualifying data. The selections you make here are processed securely in your browser and are lost forever once you close this page.

FY 2026 NC Income Limits (Median Family: $97,900)

Income Limit	1-Person	2-Person	3-Person	4-Person
Extremely Low	$20,550	$23,500	$26,450	$29,350
Very Low	$34,300	$39,200	$44,100	$48,950
Low	$54,850	$62,650	$70,500	$78,300

I have reviewed the income chart above and believe my household income qualifies for assistance.

Which property are you applying for?

Total Expected Household Size:

Website

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 Property Name (Required):

New Blevins Fitts-Powell

First Name:

Last Name:

Current Address:

City:

State:

Zip Code:

Birth Date:

Place of Birth (City & State):

Home Phone:

Work/Cell Phone:

Email Address:

Gender (Optional):

1. Household Composition

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

Housing Questionnaire

2. Are you 62 years of age or older?

Yes No

3. Are you or any other occupant of the household a part-time or full-time student?

Yes No

If yes, are you enrolled as a student at an institute of higher learning?

Yes No

4. Do you anticipate any change in your household composition (i.e. Pregnancy)?

Yes No

If yes, please give an anticipated date of change:

5. Are you a part of any Military branch?

Yes No

If yes, which status applies?

Active Reserved Veteran

6. Do you plan to bring a pet?

Yes No

Is it a service animal?

Yes No

7. Are you a qualified individual with a disability?

Yes No

8. How many bedrooms are you requesting?

One Two Three

9. Would you require an accessible unit?

Yes No

If yes, which type?

Mobility Visual Audio

10. Have you ever been evicted from a federal subsidized housing unit?

Yes No

If yes, please provide details:

Name of Property:

Phone Number:

Name of Manager: Date of eviction:

11. What are your sources of Income?

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.

Data Retention & Privacy: By checking this box, you acknowledge that your information is securely stored in accordance with our Privacy Policy. If you prefer to opt out of online submission, please leave this unchecked, download the application, and complete it by hand.

I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that providing false information may result in the rejection of my application.

Electronic Signature (Type Full Name) (Required):

Date: