BOSTON HOUSING AUTHORITY Phone: 617-988-3400 Occupancy Department Fax: 617-988-4214 56 Chauncy Street, 1st Floor TDD: 800-545-1833 x420 Boston, Massachusetts 02111 www.BostonHousing.org

(This information is available in an alternative format upon request.)

HOUSING CHOICE VOUCHER PROJECT BASED PROGRAMS CHOICE CHANGE REMOVE FORM

Name: ______SS#: ______

IA. ELDERLY/DISABLED HOUSING CHOICE VOUCHER PROGRAM PROJECT-BASED SITES Note: Be advised, the Head or Co-Head must be Elderly (62 years or age or older) or Disabled AND must qualify as a Priority One Applicant in order to apply for the Sites listed below.

Check Box () Site Name Neighborhood Bedroom Wheelchair Circle Size (s) Access? Here SRO, Studio, 1 Yes Remove Ashford Street Lodging Allston Boston Hope Dorchester 1, 2 Yes Remove Boston SRO Yes Remove Bowdoin Manor- Supported Housing Brighton Studio Yes Remove Corey Seton Manor-Supported Housing

Egleston Crossing Roxbury 1, 2 No Remove Jamaica Plain SRO Yes Remove Green Street – Supported Housing Jamaica Plain SRO Yes Remove Hearth at Burroughs LLC- Supported Housing Dorchester 1 Yes Remove Hearth at Olmsted Green – Supported Housing

Imani House Dorchester Studio,1 Yes Remove

Rutland Square House Boston 2 Yes Remove Mattapan Studio, 1 Yes Remove The Foley- Supported Housing

Uphams Corner – Supported Housing Dorchester Studio Yes Remove

Walnut House Roxbury Studio Yes Remove Boston SRO Yes Remove Washington Street – Supported Housing

Ziegler- Supported Housing Boston SRO No Remove

IB. ELDERLY/DISABLED HOUSING CHOICE VOUCHER PROGRAM PROJECT-BASED SITES Note: Be advised, the Head or Co-Head must be Elderly (62 years or age or older) or Disabled in order to apply for the Sites listed below. These sites are OPEN to Priority One AND Non-Priority or Standard Applicants.

Heritage Apts. East Boston Studio, 1 & 2 Yes Remove

Lower Mills Dorchester Studio, 1 & 2 Yes Remove

II. ELDERLY HOUSING CHOICE VOUCHER PROGRAM PROJECT-BASED SITES Note: Be advised, the Head or Co-Head must be Elderly (62 years or age or older). These sites are OPEN to Priority One and Non-Priority or Standard elderly applicants.

Amory Street Apts. Roxbury Studio, 1 & 2 Yes Remove

Building 104 Charlestown 1 Yes Remove

Central Boston Elder Services Boston 1 No Remove

Morville House Boston 1 Yes Remove

O’Connor Way Senior Housing South Boston 1 Yes Remove

Quincy Commons Roxbury 1 Yes Remove

I understand that the BHA will make a determination of my preliminary eligibility for all the sites that I have selected.

______Date: ______

Head of Household Signature

Choice Change REMOVE Housing Choice Voucher Project Based Programs Rev. 8/10/2020 HOUSING CHOICE VOUCHER PROJECT BASED PROGRAMSCHOICE(S) FORM

III. FAMILY HOUSING CHOICE VOUCHER PROGRAM PROJECT-BASED SITES (PBV) Note: Anyone may apply for these Sites as long as the bedroom size required exists at the selected choice(s).

Check Box () Site Name Neighborhood Bedroom Wheelchair Circle Size(s) Access? Here Amory Street Families Support Services Roxbury 0,1 Yes Remove Bloomfield Gardens Dorchester 2, 3 No Remove Boston Hope Dorchester 3, 4 Yes Remove Brighton Allston Apts. Brighton/Allston 2 No Remove Camden Apts South End/Roxbury 1, 2, 3 Yes Remove Catherine Gallagher Jamaica Plain 1, 2, 3, 4 No Remove 225 Centre Street Jamaica Plain 1, 2, 3 Yes Remove Condor Havre Garden East Boston 2, 3 Yes Remove Cortes Lodging House Boston SRO, Studio Yes Remove Crawford House – Supported Housing Dorchester 2 Yes Remove Dartmouth Hotel – Supported Housing Roxbury Studio, 1 Yes Remove Dixwell Park Boston 2, 3 No Remove Dudley Greenville Roxbury 2, 3 No Remove Dunmore Place – Supported Housing Roxbury 2,3 No Remove Egleston Crossing Roxbury 2 No Remove Franklin Hill Dorchester 1, 2, 3, 4,5 No Remove Georgetowne Houses I and II Hyde Park 1, 2, 3 Yes Remove Hartwell Terrace Dorchester 2 No Remove Harvard Commons Dorchester 2, 3, 4 Yes Remove Harvard Hill Apts. Dorchester 2, 3 No Remove Heritage Apts. East Boston 3,4 Yes Remove Howard Dacia Dorchester 2, 3 Yes Remove JP Scattered Sites Jamaica Plain 2,3 No Remove Lower Roxbury Apts. Roxbury 2, 3, 4 No Remove Lucerne Gardens Dorchester 2, 3 Yes Remove 698 Mass. Ave Boston SRO Yes Remove Madison Melena Cass Apt. Roxbury 1, 2,3,4 Yes Remove Mattapan Heights Mattapan 1, 2 Yes Remove Moreland Affordable Roxbury 2, 3 No Remove 109 Mt. Pleasant Street – Supported Housing Roxbury 2, 3 No Remove Nazing Court Dorchester 1, 2 No Remove Nueva Esperanza Roxbury Studio Yes Remove Oak Terrace Boston 1, 2, 3, 4 No Remove Old Colony Phase I & II South Boston 1, 2, 3, 4 Yes Remove Oliver Lofts Roxbury 1,2 No Remove Olmsted Green Dorchester 2, 3 No Remove Orient Heights Phase Two East Boston 1, 2, 3,4 Yes Remove Pleasant Street – Supported Housing Dorchester 2 No Remove Rockvale Circle Jamaica Plain 2, 3 No Remove Rollins Square Boston 1 ,2, 3 Yes Remove Roxbury Tenant of Harvard Roxbury 1, 2, 3 No Remove Rutland Square House South End SRO, 2 Yes Remove The Berkeley Residence Boston SRO Yes Remove The Greenway/Maverick East Boston 3 No Remove The Metropolitan Boston Studio Yes Remove Trinity House East Boston SRO, Studio Yes Remove Trinity Terrace Dorchester 2, 3 Yes Remove Uphams West Dorchester 2 No Remove 40 Upton Street – Supported Housing Boston SRO Yes Remove Washington Beech Roslindale 1, 2, 3, 4 No Remove 9 Williams Street Boston 1,2 Yes Remove Westland/Burbank Boston 1, 2 Yes Remove Westminister Court Roxbury 1, 2 Yes Remove

Wise Street – Supported Housing Jamaica Plain 1 Yes Remove Whittier Street Apartments South End 2, 3, 4 Yes Remove

I understand that the BHA will make a determination of my preliminary eligibility for all the sites that I have selected.

______Date: ______Head of Household Signature Housing Choice Change REMOVE Housing Choice Voucher Project Based Programs Rev. 8/10/2020