CONSENT

I, _________________________________________________ hereby consent to the following:

(print or type first name, middle initial, last name)

• 1, The use of the attached evidence to verify my eligible immigration status to enable me to receive financial assistance for housing; and

• 2, The release of such evidence of eligible immigration status by the project owner without responsibility for the further use or transmission of the evidence by the entity receiving it to the following:

  • a. HUD, as required by HUD; and

  • b. The DHS for purposes of verification of the immigration status of the individual.