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Residents: Community Service Requirement Waiver

Easley Housing Logo
Phone: 864.855.0629 | Fax: 864.855.0864
103 Wallace Drive, Easley, SC 29640
EasleyHousing.org

[{"type":"text","required":true,"label":"First Name","name":"First-Name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Middle Name","name":"middle-name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Last Name","name":"last-name","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Tenant Number","name":"Tenant-Number","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Street Address","name":"Street-Address","className":"col-md-6","subtype":"text"},{"type":"text","label":"Apartment Number","name":"Apartment-Number","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"City","name":"City","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"State","name":"State","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC","selected":true},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"Zip Code","name":"Zip-Code","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"Phone Number","name":"Phone-Number","className":"col-md-6"},{"type":"text","required":true,"label":"Head of Household Name","name":"Head-of-Household-Name","className":"col-md-6","subtype":"text"},{"type":"checkbox-group","required":true,"label":"Relationship to Head of Household","name":"Relationship-to-Head-of-Household","other":true,"className":"d-block","values":[{"label":"Self","value":"Self"},{"label":"Spouse","value":"Spouse"},{"label":"Child","value":"Child"}]},{"type":"checkbox-group","required":true,"label":"I, the undersigned, submit that I am exempt from fulfilling the Community Service Requirement for the following reason/s:","name":"I-the-undersigned-submit-that-I-am-exempt-from-fulfilling-the-Community-Service-Requirement-for-the-following-reasons","className":"d-block","values":[{"label":"I am working at least 30 hours a week","value":"I-am-working-at-least-30-hours-a-week"},{"label":"I am a full-time student","value":"I-am-a-full-time-student"},{"label":"I am receiving TANF and participating in a required economic self-sufficiency program or work activity","value":"I-am-receiving-TANF-and-participating-in-a-required-economic-self-sufficiency-program-or-work-activity"},{"label":"I have a disability ","value":"I-have-a-disability "},{"label":"I am blind","value":"I-am-blind"},{"label":"I am caring for a family member who has a disability ","value":"I-am-caring-for-a-family-member-who-has-a-disability"}]},{"type":"checkbox-group","required":true,"label":"I am uploading the following verification for the reasons noted above:","name":"I-am-uploading-the-following-verification-for-the-reasons-noted-above","className":"d-block","values":[{"label":"A letter from my employer indicating start date and number of hours each week or copies of at least three pay stubs verifying at least 30 hours each week","value":"A-letter-from-my-employer-indicating-start-date-and-number-of-hours-each-week-or-copies-of-at-least-three-pay-stubs-verifying-at-least-30-hours-each-week"},{"label":"A letter from my school or educational program or a copy of this semester’s schedule","value":"A-letter-from-my-school-or-educational-program-or-a-copy-of-this-semester’s-schedule"},{"label":"A letter from the Department of Family & Children Services verifying participation ","value":"A-letter-from-the-Department-of-Family-&-Children-Services-verifying-participation"},{"label":"A copy of my SSI letter, Social Security or SS-Disability Letter or Letter from my medical provider documenting the period of time that I am unable to work","value":"A-copy-of-my-SSI-letter-Social-Security-or-SS-Disability-Letter-or-Letter-from-my-medical-provider-documenting-the-period-of-time-that-I-am-unable-to-work"},{"label":"Verification of blindness","value":"Verification-of-blindness"},{"label":"A letter from my medical provider verifying family member’s need for caretaker and SSI Letter or SS-Disability Letter from family member with disability","value":"A-letter-from-my-medical-provider-verifying-family-member’s-need-for-caretaker-and-SSI-Letter-or-SS-Disability-Letter-from-family-member-with-disability"}]},{"type":"file","label":"File Upload for Verification","name":"File-Upload-for-Verification","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":" (This form will allow upload of up to 20 files (35 Mb     total of all files) in PDF, JPG or JPEG format.)","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I, certify that the information above is correct.","className":"d-block"},{"type":"text","required":true,"label":"Signature","name":"Signature","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Date of Signature","name":"Date-of-Signature","className":"col-md-6"}]