Senior Housing Programs
21 Court Street
Vernon, CT  06066
860-871-0886

Thank you for you recent inquiry into affordable housing.  Please complete the form below and submit as indicated.  This will help us to determine if you are eligible for the program.  Then someone will contact you for an applicant interview.

Your First Name:       

Your Last Name:       

Address:                   

City/Town:               

State:                       

Area Code:              

Phone #:                   

Names of All Family Members To Be Housed:

    1. 
    2. 
    3. 
    4. 
    5. 
    6. 
    7. 
    8. 

Total Monthly Income:   $

Please Select The Housing You Are In Need Of:

Please Use The Space Below To Write Any Comments You Feel Would Help Us Assess Your Needs :

When You Have Completed The Form, Please Click the "Submit" Button , Below and Thank You!