AP4H – Self Declaration

Remember to email (ap4hupdate@associatedministries.org) or fax 253-383-2672 your updated income statements.

Your information will not be updated until we have received all of your required documents.  If you have any questions, please call us @ 253-682-3401.

Self Declaration of Housing Status

Declaration of Homelessness
  • This is to certify that the above named individual or household is currently homeless or at-risk of homelessness, based on the following and other indicated information and the signed declaration by the applicant.

  • I certify that the information above and any other information provided in applying for housing assistance is true, accurate, and complete.

  • To be completed by AP4H Staff

  • Access Point for Housing Staff Certification

  • I understand that third-party verification is the preferred method of certifying homelessness or risk of homelessness for an individual who is seeking housing assistance. I understand that self-declaration is only permitted when I have attempted to, but cannot obtain, third party verification.