Submit an Application for Affordable Housing ...

Welcome to the online application form provided for Mountain Cap of WV Inc a CDC in Buckhannon, Alabama.

To submit an application for affordable housing, complete the information below ( tabbing through each item ) and click-on the Submit Request button provided at the bottom of this page. Your application will be immediately sent to Mountain Cap of WV Inc a CDC and processed in the order it was received. A representative will be contacting you to review your application information and housing availability options with you. If you have any other questions or concerns about your application submission, please feel free to call (304) 472-1515 or send an email directly to sleggett@mountaincapwv.org.

Apartment Information

Head Household Member Information

First Name

Middle Name

Last Name

Last 4 Digits of Social Security #

Birth Date

Gender

Race

Ethnicity

Current Contact Information

Address

City

State

Zip

Phone Number

Email Address

Household Makeup Information

Members that are under the age of 18 or are full-time students

Members that are 62 years of age or older

Members that are Handicapped or Disabled

Total Number of Household Members

Household Income, Asset and Expense Information

Employment / Business

Social Security / Pension

Public Assistance

Other Income

Estimated Value of all Assets ( Checking, Savings, CD’s, etc. )

Estimated Annual Income from all Assets

Estimated Annual Medical Expenses For Elderly, Handicap/Disabled Members Only

Estimated Annual Handicap Expenses that enable a Handicap/Disabled Member to Work

Estimated Annual Child Care Expenses that enable a Member to Work

Additional information or comments you would like to make :

Your Message

Mountain Cap of WV Inc a CDC