This Box Is for Office Use Only s1

This box is for Office Use Only Date of Receipt: Time of Receipt: Control Number: Barrier fee: First Floor: Elderly Handicapped: BaküsMutambTdæa Race and/or Ethnicity: Priority /Preference Category: nsklsMrab;TICRmkp Language: þl;CMnYyedayrdæ MRVP, & AHVP

BaküsMumineBjelj nwgminRtUv)andMeNIrkareT. sUmbMeBjB½t’manTaMgGs;Edl)anesñIsMuenAelIBaküsMu. RbsinebIsMNYrminBak;B½n§ sUmsresrfa minBak;B½n§. sUm R)akdfaGñkcuHhtßelxaelITMB½rcugeRkay. RbsinebIGñkRtUvkarcenøaHbEnßmedIm,Ipþl;cmøIy sUmP ¢ab;snøwkbEnßm. enAeBlbMeBjrYc sUmepJIr b¤kan;edaypÞal;édmk kan;GaCJaFrpþl;TICRmkkñúgtMbn; EdlGñkcg;dak;BaküsMu. sUmBinitübBa ¢IrayGaCJaFrpþl;TICRmkkñúgtMbn; sMrab;lT§PaBGacmanTICRmksMrab;RKYsar b¤cas;Cra¼CnBikar minEmncas;Cra.

1. eQµaHGñkdak; BaküsMu³ Gapat; Gasydæansñak; Emnf_e enAbc©úb,nñ ³ lx³ hSIbk Rkug¼TIRkug ³ rdæ ³ Ud ³ TUrs½BÞenApÞ TUrs½ H ³ BÞéd ³ TUrs½ elxRbesIrbMput BÞkEnø edIm,ICYbGñkd geFVIk ak;BaküsMu³ ar³ Gapat; GasydæanepJIr Emnf_e sMbuRt ³ lx³ rd hSIbkU Rkug¼TIRkug ³ æ ³ d ³ ©2004 Commonwealth of Massachusetts Page 1 of 19 Revised November 2008 Department of Housing & Community Development Khmer 2. RbePTTICRmksaFarN³EdlGñkkMBugdak;BaküsMu ³: Elderly Non-Elderly, Handicapped

Congregate Elderly/Handicapped Family MRVP AHVP cMNaM ³ edIm,ImanlkçN³sm,tþiTTYl)anTICRmksMrab;Cncas;Cra¼Cn Bikar GñkRtUvEtmanGayuy:agtic 60 qñaM b¤CamnusSBikar. RbsinebIGñkmanPaB Bikar PaBBikarRtuvEtminEmnCamkkaresBeRKOgRsvwg¼fñaMejó n. RbsinebIGñkmanPaBBikar GñkRtUvEtpþl;esckþIbBa ¢ak;edayevC¢bNÐitEdlbBa¢ak; c,as;fa GñkmanPaBBikar ehIyRtUv)anrMBwgTukfamanryéeBlyUr nigminkMNt;y:agehacNas;R)aMmYyEx. CagenHeTot LHA nwgRtUvkMNt;fa lkçN³TRmg;BiessCak;lak; b¤ TICRmkmanéføQñÜlTab minGacmanenAkñúgTIpSarÉkCn ehIyfa Gñkdak;BaküsMuRbQmmuxnwgkars;enAkñúgmnÞIr b¤ TICRmkeRkambTdæandundab b¤Gñkdak;BaküsMukMBugbg;éføQñÜleRcInhYs. 3. RbsinebIGñkcg;dak;BaküsMuTICRmkbnÞan; GñkRtUvEteRCIserIsmYykñúgcMeNamRbePTxageRkam ³ cMNaM ³ edIm,ImanlkçN³sm,tþisMrab;sßanPaBGñkdak;BaküsMubnÞa n; GñkRtUvEt {minmanpÞHsEm,g} EdlRtUv)ankMNt;edaybTb,BaØtþirdæfaCa ³ Gñkdak; BaküsMuEdlminmankEnøgrs;enA b¤EdlkMBugsßitkñúgsßanPaBrs;enAEdlmankarKMramkMEh gxøaMg bnÞan; nigpÞal;dl;Civit b¤suvtßiPaB EdlnwgRtUv)an kat;bnßyedaykardak;enAkñúgkEnøgsñak;enAsmrmü Edlmin)anbNþal[ b¤rYmcMENkxøaMgcMeBaHsßanPaBenH Edl)aneFVIkarxitxMRbwgERbgbMput edIm,I Tb;sáat;sßanPaB nigrkkEnøgsñak;enAepSg nigGñkEdlRtUv)andkecjBIkEnøgsñak;enAcm,grbs;xøÜneday sarmUlehtumYykñúgcMeNammUlehtuxag eRkam. sUmKUsykmUlehtuEdlBak;B½n§cMeBaHsßanPaBrbs;Gñk. RtUv)andkecjedayeRKaHFmµCati ¬]TahrN_ GKÁIP½y TwkCMnn; rBa¢ÜydI¦

©2004 Commonwealth of Massachusetts Page 2 of 19 Revised November 2008 Department of Housing & Community Development Khmer RtUv)andkecjedayviFankarN_saFarN³ ¬karEklMGTIRkugfµI tMbn;RtYtRtasMxan;²¦ RtUv)andkecjedayviFankarN_saFarN³ ¬karminyl;RBmcMeBaHpÞH karbMBanRkm¦ RtUv)andkecjedaykarminmankMhusénTICRmk PaBGasnñevC¢sa®sþF¶n;F¶r nig¼b¤CnrgeRKaHénkarbMBan ¬GMeBIhigSakñúgRKYsar¦ EdlsßanPaBTICRmk rYmcMENky:agsMxan; b¤KWCakarKMramkMEhgpÞal;cMeBaHCivit nigsuvtßiPaBrbs;Gñkdak;BaküsMu.

RbsinebIGñk)aneRCIserIsmYykñúgcMeNamRbePTPaB bnÞan;xagelIenAkñúgEpñkenH GñkRtUvEtbMeBjBaküsMubnÞan; bEnßmeTAelIBaküsMutambTdæanenH. ral;BaküsMubnÞan;TaMgGs; RtUvEtP ¢ab;CamYyedayÉksarCalaylkçN_GkSrrbs;ttiyPaKI.

©2004 Commonwealth of Massachusetts Page 3 of 19 Revised November 2008 Department of Housing & Community Development Khmer 4. karcg;)antMbn; ³ bEnßmeTAelIkarTTYl)ankarcg;)antMbn;sMrab;TIRkug b¤RkugEdlGñksñak;enAeKal GñkGacTTYl)ankarcg;)antMbn; Ep¥ktamkEnøgEdlGñkeFVIkar. sUmeqøIydUcxageRkam ³  pþl;CUneQµaHTIRkug¼RkugEdlG ñkeFVIkar ³  pþl;CUnkalbriecäTé dl; nkareFVIkar ³ BI ³ ³ TUrs ½BÞe nA kEnø TUrs½BÞenA geFVI pÞH - - kar - -

5. karcg;)anénGtIteyaFa ³ sMrab;Et Family Housing: GñkGacdak;BaküsMukarcg;)anénGtIteyaFa RbsinebIGñkCaGtIteyaFa bþI-RbBn§ bþI- RbBn§EdlenArs; «Bukmþay b¤kUnEdlsßitkñúgbnÞúk b¤bþI- RbBn§Edl)anElglHCamYykUnkñúgbnÞúkrbs;GtIt a. eyaFa.

sMrab;Et Elderly / Handicapped Housing: GñkGacdak;BaküsMusMrab;karcg;)anénGtIteya Fa RbsinebIGñkCaeyaFaEdlsñak;enATIRkug¼Rkug b. enH. RbsinebIGñkcg;dak;BaküsMukarcg;)anénGtIteyaFa ©2004 Commonwealth of Massachusetts Page 4 of 19 Revised November 2008 Department of Housing & Community Development Khmer sUmraybgðajkalbriecäTénkarbeRmIeyaFaGaemrik. sUmbBa©ÚlkalbriecäTsMrab;karbeRmI T½BeCIgeKak T½BeCIgTwk qµaMsmuRT T½BGakas b¤qµaMRbeTs. kalbriecäTb dl; ³ eRmI ³ BI ³ sMeNAcmøgénTRmg; DD214 rbs;RksYgkarBarCatirbs;GtIteyaFa RtUvEtdak;CUnCamYyBaküsMuenH.

6. etIGñkmantRmUvkarBiessedaysarEtBikarPaB b¤tRmUvkarkarsRmbsRmYlsmrmüdUcCakEnøgsñak;en ACan;TImYysMrab;mUlehtuevC¢sa®sþ EdreT? )aT- cas eT sUmbBa ¢ak; ³

7. etIGñkRtUvkarGapat;Emnf_EdlGaccUleRbIekAGIrujEdr eT? )aT-cas eT

8. cMnYnbnÞb;eKgcaM)ac; ³ 1 2 3 4 5 cMNaM ³ karGPivDÆn_TICRmksMrab;Cncas;Cra¼CnBikarPaKeRcIn bMput manEtkEnøgsñak;enAbnÞb;eKg 1 Etb:ueNÑaH.

9. etIbc©úb,nñGñkkMBugsñak;enAkñúgTIRCmkepÞrmin Gcié®nþy_ EdlRtUv)anpþl;CMnYysßiteRkamkmµviFI Massachusetts Alternative Housing Voucher Program EdreT? )aT-cas eT

©2004 Commonwealth of Massachusetts Page 5 of 19 Revised November 2008 Department of Housing & Community Development Khmer 10. etInrNamñak;enAkñúgRKYsarrbs;GñkmanLanEdreT? ) aT-cas eT m:akLa qña elxcuHb n ³ M ³ Ba¢I ³

m:akLa qña elxcuHb n ³ M ³ Ba¢I ³

11. smaCikRKYsarEdlRtUvrs;enAkñúgkEnøgsñak;enA edayrYmbBa©ÚlTaMgemRKYsar ³ namRtkUl TMnak sBa CnC elxsnþ eP éf¶ muxrbr nignamxøÜn ;TMng ¢at ati** isux T Exq  man CamY i* sgÁm** ñaM kargar y * kMe eFVI emRK NIt  enA Ysar pÞH  Bika r  sisS- nisSit

*sBa¢ati ³ Gaemrikkat;\NÐa b¤CnCatiedImGaLasáa GasuI Es,kexµA b¤GaRhVikkat;Gaemrik CnCatiedImhaév: ©2004 Commonwealth of Massachusetts Page 6 of 19 Revised November 2008 Department of Housing & Community Development Khmer b¤GñkekaH)a:suIhVikepSgeTot Es,ks epSg² ¬sUmbBa¢ak;¦. **CnCati ³ eGs,:aj¼Gaemrikxagt,Úg b¤minEmneGs,:aj¼Gaemrikxagt,Úg kareqøIytbnwgsMNYrTaMgenHKWCakarbnÞab;bnSM. sßanPaBrbs;GñkBak;B½n§nwgnItiviFIeRCIserIsGñkCYl Gacb:HBal;edayB½t’manenH. {CnCatiPaKtic} min bBa©Úlkñúg {Es,ks} eLIy ebIBuMenaHeTluHRtaEtmankarkMNt;sBa¢atiepSgeTot b¤ {eGs,:aj¼Gaemrikxagt,Úg}. ***B½t’manenH nwgRtUv)aneRbIR)as;edIm,IepÞógpÞat;R)ak;cMNUl RTBüsm,tþi nigB½t’manGMBIkMNt;RtabTelµIs.

12. etImankarrMBwgTukfapøas;bþÚrsmasPaBRKYsarEdreT? )aT-cas eT RbsinebI)a T-cas etIRbePTd UcemþcEd enAe r? BlNa?

©2004 Commonwealth of Massachusetts Page 7 of 19 Revised November 2008 Department of Housing & Community Development Khmer 13. R)ak;cMNUlmunkarkat;Tuk ³ ) a:n;sµanR)ak;cMNUldulrMBwgTuksMrab;smaCikRKYsar TaMgGs; BIRbPBTaMgGs;sMrab;ry³eBl 12 bnÞab;. sUmbBa ¢ak;RbPBTaMgGs;.

eQµaH nigGasydæan nieyaCk R)ak;cMNUldu eQµaHsmaCi b¤RbPBénR)a lsMrab;ry³eBl kRKYsar k;cMNUl 12 ExbnÞab; ebovtS R)ak;QñÜl rYmTaMgR)ak ;Efmem:ag luyFIb $ ebovtS R)ak;QñÜl rYmTaMgR)ak ;Efmem:ag luyFIb $ R)ak;cMNUlsu T§BIGaCIvkmµ b¤GaCIB $ R)ak;cMNUlBI mUlniFi karR)ak; PaKlaP $ sMNgBIPaBGt; kargareFVI b¤BikarPaB $ esaFnnivtþn_ $

GtßRbeyaCn_ snþisuxsgÁm CaRbcaM nig¼b¤ SSI $ R)ak;cMNUlBI BikarPaB VA

$ TAFDC b¤CMnYysaFa rN³ $ R)ak;CMnYybn Þab;BIkarElgl HCaRbcaM $ R)ak;cMNUlep SgeTot $

R)ak;cMNUldulsrub ³ $

karcMNayevC $ ¢sa®sþEdlminsgm kvij ³

R)ak;]btßmÖkUnbn $ Þab;BIkarElglH ³ karFanara:b;rgsux $ PaB ³

epSg² ³ ¬]TahrN_ karcMNaysMrab;karEf $ TaMkUnQW b¤CnGsmtßPaBQW RbsinebIcaM)ac;sMra b;kargar¦

15. RTBüsm,tþi ³ etIGñkmanGcln³RTBüpÞal;xøÜnEdreT? )aT-cas eT RbsinebI)aT-cas sUmpþl;Gasydæan ³ sUmraybgðajRTBüsm,tþirbs;RKb;²KñaEdlRtUvrs;enAkñúg kEnøgsñak;enA. sUmbBa¢ak;KNnIFnaKarTaMgGs; PaKh‘un mUlb½Rt mUlniFi Gcln³RTBü.l. sUmkMubBa©ÚlsMelokbMBak; sgðarwm b¤Lan. sUmeRbIR)as;RkdasbEnßmRbsinebIcaM)ac;. RbePTRTB eQµaHsßa elxKNnI smaCikRKYs üsm,tþi témøRT b½nhirBa ar Büsm,tþi Øvtßú b¤smtul übc©úb,

16. etIGñk)anlk; epÞr b¤pþl;Gcln³RTBü b¤RTBüsm,tþienAkñúgry³eBlbI (3) qñaMcugeRkayEdreT? ) aT-cas eT

Rbsine bI)aT- kalbriecäTénka qña cas rlk;¼karepÞr ³ Ex éf¶ M cMnYnénkarlk; ¼karepÞr ³ témøénkarlk;¼

karepÞr ³

©2004 Commonwealth of Massachusetts Page 11 of 19 Revised November 2008 Department of Housing & Community Development Khmer 17. GñkTMnak;TMng ³ sUmraybgðajGñkTMnak;TMngBIrnak;. GñkTaMgenH minRtUvCasac;jati b¤smaCikRKYsareLIy.

(1) eQµaH elxTUrs½BÞ hSI Gasyd Rku rd bk æan ³ g æ Ud (2) eQµaH elxTUrs½BÞ hSI Gasyd Rku rd bk æan ³ g æ Ud

raybgðajGasydæansMrab;smaCikRKYsareBjv½ymña k;² sMrab;ry³eBlR)aMqñaMcugeRkayenAkñúglMdab;bRBa©a s. sUmraybgðajGñkkan;kic©snüa CYlcm,g ¬emRKYsar¦ RbsinebICanrNaeRkABIxøÜnGñk. 18. ¬sUmeRbIR)as;snøwkbEnßmRbsinebIcaM)ac;¦

(1) eQµaHGñkkan;kic©snüa cm,g ³ elx Gapa kalbr Gasydæa t;Em iecäT dl; n ³ nf_ BI ³ ³ hSI bk TIRkug rdæ Ud eQµaHm ©as;pÞH ³ elxTUrs½BÞ Gasydæa hSI nm©as;p TIRk rd bk ÞH ³ ug æ Ud

©2004 Commonwealth of Massachusetts Page 12 of 19 Revised November 2008 Department of Housing & Community Development Khmer etIm©as;pÞHenH)annaMmknUvviFankarN_tulakarNamYy cMeBaHGñkkan;kic©snüaCYl b¤GñkEdreT? (KUsykmYy) )aT-cas eT etIm©as;pÞHenHbgVilR)ak;kk;suvtßiPaBrbs;GñkvijEdreT ? (KUsykmYy) )aT-cas eT mindwg

(2) eQµaHGñkkan;kic©snüa cm,g ³ elx Gapa kalbr Gasydæa t;Em iecäT dl; n ³ nf_ BI ³ ³ hSI bk TIRkug rdæ Ud eQµaHm ©as;pÞH ³ elxTUrs½BÞ Gasydæa hSI nm©as;p TIRk rd bk ÞH ³ ug æ Ud etIm©as;pÞHenH)annaMmknUvviFankarN_tulakarNamYy cMeBaHGñkkan;kic©snüaCYl b¤GñkEdreT? (KUsykmYy) )aT-cas eT etIm©as;pÞHenHbgVilR)ak;kk;suvtßiPaBrbs;GñkvijEdreT ? (KUsykmYy) )aT-cas eT mindwg

(3) eQµaHGñkkan;kic©snüa cm,g ³ elx Gapa kalbr Gasydæa t;Em iecäT dl; n ³ nf_ BI ³ ³ rdæ hSI TIRkug bk

©2004 Commonwealth of Massachusetts Page 13 of 19 Revised November 2008 Department of Housing & Community Development Khmer Ud eQµaHm ©as;pÞH ³ elxTUrs½BÞ Gasydæa hSI nm©as;p TIRk rd bk ÞH ³ ug æ Ud etIm©as;pÞHenH)annaMmknUvviFankarN_tulakarNamYy cMeBaHGñkkan;kic©snüaCYl b¤GñkEdreT? (KUsykmYy) )aT-cas eT etIm©as;pÞHenHbgVilR)ak;kk;suvtßiPaBrbs;GñkvijEdreT ? (KUsykmYy) )aT-cas eT mindwg

19. etIGñk b¤smaCikNamYyénRKYsarrbs;Gñk Føab;TTYl)anCMnYypþl;TICRmkBIPñak;garpþl;TICRmken H b¤epSgeTotNamYyEdreT? (KUsykmYy) )aT-cas eT

RbsinebI)aT-cas sUmpþl;eQµaHemRKYs arnaeBlenaH ³ TMnak;TMngCamYyGñk dak;BaküsMu ³ eQµaHPñak;garpþl;TIC Rmk kalbriecäTEdl)anerIecj ³

mUleh tuEdl) anerIe cj ³ enAeBlEdlGñk)anerIecj etIGñk)anGnuvtþtamkic©snüaCYl nigesckþItRmUvénkmµviFIepSgeTotEdreT? (KUsykmYy) )aT-cas ©2004 Commonwealth of Massachusetts Page 14 of 19 Revised November 2008 Department of Housing & Community Development Khmer eT

Rbsine bIeT sUmBn ül; ³

20. etIGñkKWCasmaCikRkumRbwkSaPi)al nieyaCik b¤smaCikRKYsarsac;CiténnieyaCikrbs;smaCikRkumRbwk sarbs;GaCJaFrpþl;TICRmkenHEdreT? )aT-cas eT RbsinebIdUecñH enHnwgmincaM)ac;dklkçN³sm,tþiénBaküsMurbs;Gñkecje LIy.

Rbsine bI)aT- cas sUmBn ül; ³

sUmero brab; ³

22: GñkTMnak;TMngeBlmanGasnñ ³ eQµaHsac;jati b¤mitþPkþiEdlminmanKeRmagrs;enACamYyGñk. eyIg ´nwgTak;TgmnusSenH RbsinebIeyIg´ minGacCYbGñk)anenAkñúgkrNIGasnñ. eQµa TMnak; H ³ TMng ³

Gasyd Rkug rd h æan ³ ³ æ ³ SI b

GuIe m:l ³

©2004 Commonwealth of Massachusetts Page 16 of 19 Revised November 2008 Department of Housing & Community Development Khmer 23. kMNt;RtabTelµIs ³ etIGñk b¤smaCikNamYyénRKYsarrbs;GñkEdlnwgrs;enAkñúgkE nøgsñak;enA Føab;RtUv)anecaTRbkan;GMBIbTelµIsEdreT? )aT-cas eT

Rbsine bI)aT- cas sUmBn ül; ³

24. etIGñk b¤smaCikNamYyénRKYsarrbs;GñkEdlnwgrs;enAkñúgkE nøgsñak;enA manbBaðabTelµIsNamYykMBugrg;caMesckþIseRmcEdr eT? )aT-cas eT Rbsine bI)aT- cas sUmBn ül; ³

esckþIbBa¢ak;rbs;Gñkdak;BaküsMu ³ ´dwgfa BaküsMuenHminEmnCakarpþl;CUnTICRmkeLIy. ´dwgfa GaCJaFrpþl;TICRmk nwgminpþl;kEnøgsñak;enAénTICRmksaFarN³smrmü elIsBImYyeLIy. RbsinebI´minTTYlyksMeNI BaküsMurbs;

©2004 Commonwealth of Massachusetts Page 17 of 19 Revised November 2008 Department of Housing & Community Development Khmer ´nwgRtUv)andkecjBIbBa¢Irg;caM ehIyRbsinebI ´dak;BaküsMueLIgvij BaküsMu rbs; ´nwgminTTYl)ansßanPaBGaTiPaB b¤karcg;)anNamYyEdlRtUv)anpþl;CUnelIBaküsMuBImu nsMrab;ry³eBlbI (3) qñaM. Ep¥ktamBaküsMuenH ´dwgfa ´minRtUveFVIKeRmagNamYyedIm,Icakecj b¤bBa©b;karCYlbc©úb,nñrbs;´ rhUtTal;Et´)an TTYlsMeNIpþl;kEnøg sñak;enACalaylkçN_GkSrBIGaCJaFrpþl;TICRmk. ´dwgfa vaKWCakarTTYlxusRtUvrbs;´kñúgkar CUndMNwgGaCJaFrpþl;TICRmkCalaylkçN_ GkSrGMBIkarpøas;bþÚrNamYyénGasydæan R)ak;cMNUl b¤smasPaBRKYsar. ´sUmGnuBaØat[GaCJaFrpþl;TICRmkeFVIkaresuIbGegát edIm,I epÞógpÞat;B½t’manEdl ´)anpþl;CUnenAkñúgBaküsMuenH. ´sUmbBa¢ak;fa B½t’manEdl ´)anpþl;CUnenAkñúgBaküsMuenHKWCakarBit nigRtwmRtUv. ´dwgfa esckþIbBa¢ak;minRtwmRtUv b¤ karbgðajminRtwmRtUvNamYy GacnaM[mankarbdiesFBaküsMurbs;´. ´dwgfa GaCJaFrpþl;TICRmk nwgesñIsMuB½t’manGMBIkMNt;RtabTelµIsBIRku mRbwkSaRKb;RKgRbB½n§RbvtþibTelµIs nigeFVIkarBinitüPaBeCOCak; RBmTaMgkarRsavRCavtam GuinF½rNitsMrab;smaCikRKYsareBjv½yTaMgGs;. RtUv)ancuHhtßelxaedaysßiteRkamkarQWcab; nigkarBin½yénkarPUtPr. ©2004 Commonwealth of Massachusetts Page 18 of 19 Revised November 2008 Department of Housing & Community Development Khmer ´dwgfasMeNAcmøgénBaküsMuenH nigsMeNAcmøgén htßelxaenH mansuBlPaBdUcc,ab;edImEdr. htßelxarbs;Gñ kdak;BaküsMu kalbri ³ ecäT ³ htßelxarbs;Gñ kalbri kBinitü ³ ecäT ³