Town Appointed Tenant Board Member Waiver
LHAs that wish to apply for a waiver of the Town Appointed Board Member requirement must fill out the form below. Please choose the correct waiver type and fill out the form completely. See PHN 2021-01 for additional information about requesting waivers.
LHA Name
(Required)
Abington Housing Authority
Acton Housing Authority
Acushnet Housing Authority
Adams Housing Authority
Agawam Housing Authority
Amesbury Housing Authority
Amherst Housing Authority
Andover Housing Authority
Arlington Housing Authority
Ashland Housing Authority
Athol Housing Authority
Attleboro Housing Authority
Auburn Housing Authority
Avon Housing Authority
Ayer Housing Authority
Barnstable Housing Authority
Barre Housing Authority
Bedford Housing Authority
Belchertown Housing Authority
Bellingham Housing Authority
Belmont Housing Authority
Beverly Housing Authority
Billerica Housing Authority
Blackstone Housing Authority
Boston Housing Authority
Bourne Housing Authority
Braintree Housing Authority
Brewster Housing Authority
Bridgewater Housing Authority
Brimfield Housing Authority
Brockton Housing Authority
Brookline Housing Authority
Burlington Housing Authority
Cambridge Housing Authority
Canton Housing Authority
Carver Housing Authority
Charlton Housing Authority
Chatham Housing Authority
Chelmsford Housing Authority
Chelsea Housing Authority
Chicopee Housing Authority
Clinton Housing Authority
Cohasset Housing Authority
Concord Housing Authority
Dalton Housing Authority
Danvers Housing Authority
Dartmouth Housing Authority
Dedham Housing Authority
Dennis Housing Authority
Dighton Housing Authority
Dracut Housing Authority
Dudley Housing Authority
Duxbury Housing Authority
East Bridgewater Housing Authority
East Longmeadow Housing Authority
Easthampton Housing Authority
Easton Housing Authority
Essex Housing Authority
Everett Housing Authority
Fairhaven Housing Authority
Fall River Housing Authority
Falmouth Housing Authority
Fitchburg Housing Authority
Foxborough Housing Authority
Framingham Housing Authority
Franklin Housing Authority
Gardner Housing Authority
Georgetown Housing Authority
Gloucester Housing Authority
Grafton Housing Authority
Granby Housing Authority
Greenfield Housing Authority
Groton Housing Authority
Groveland Housing Authority
Great Barrington Housing Authority
Hadley Housing Authority
Halifax Housing Authority
Hamilton Housing Authority
Hampden Housing Authority
Hanover Housing Authority
Hanson Housing Authority
Harwich Housing Authority
Hatfield Housing Authority
Haverhill Housing Authority
Hingham Housing Authority
Holbrook Housing Authority
Holden Housing Authority
Holliston Housing Authority
Holyoke Housing Authority
Hopedale Housing Authority
Hopkinton Housing Authority
Hudson Housing Authority
Hull Housing Authority
Ipswich Housing Authority
Kingston Housing Authority
Lancaster Housing Authority
Lawrence Housing Authority
Lee Housing Authority
Leicester Housing Authority
Lenox Housing Authority
Leominster Housing Authority
Lexington Housing Authority
Littleton Housing Authority
Lowell Housing Authority
Ludlow Housing Authority
Lunenburg Housing Authority
Lynn Housing Authority
Lynnfield Housing Authority
Malden Housing Authority
Manchester Housing Authority
Mansfield Housing Authority
Marblehead Housing Authority
Marlborough Housing Authority
Marshfield Housing Authority
Mashpee Housing Authority
Mattapoisett Housing Authority
Maynard Housing Authority
Medfield Housing Authority
Medford Housing Authority
Medway Housing Authority
Melrose Housing Authority
Mendon Housing Authority
Merrimac Housing Authority
Methuen Housing Authority
Middleborough Housing Authority
Middleton Housing Authority
Milford Housing Authority
Millbury Housing Authority
Millis Housing Authority
Milton Housing Authority
Monson Housing Authority
Montague Housing Authority
North Andover Housing Authority
North Attleborough Housing Authority
North Brookfield Housing Authority
North Reading Housing Authority
Nahant Housing Authority
Nantucket Housing Authority
Natick Housing Authority
Needham Housing Authority
New Bedford Housing Authority
Newburyport Housing Authority
Newton Housing Authority
Norfolk Housing Authority
North Adams Housing Authority
Northampton Housing Authority
Northborough Housing Authority
Northbridge Housing Authority
Norton Housing Authority
Norwell Housing Authority
Norwood Housing Authority
Orange Housing Authority
Orleans Housing Authority
Oxford Housing Authority
Palmer Housing Authority
Peabody Housing Authority
Pembroke Housing Authority
Pepperell Housing Authority
Pittsfield Housing Authority
Plainville Housing Authority
Plymouth Housing Authority
Provincetown Housing Authority
Quincy Housing Authority
Randolph Housing Authority
Raynham Housing Authority
Reading Housing Authority
Revere Housing Authority
Rockland Housing Authority
Rockport Housing Authority
Rowley Housing Authority
Salem Housing Authority
Salisbury Housing Authority
Sandwich Housing Authority
Saugus Housing Authority
Scituate Housing Authority
Seekonk Housing Authority
Sharon Housing Authority
Shelburne Housing Authority
Shrewsbury Housing Authority
Somerset Housing Authority
Somerville Housing Authority
South Hadley Housing Authority
Southborough Housing Authority
Southbridge Housing Authority
Southwick Housing Authority
Spencer Housing Authority
Springfield Housing Authority
Sterling Housing Authority
Stockbridge Housing Authority
Stoneham Housing Authority
Stoughton Housing Authority
Sudbury Housing Authority
Sutton Housing Authority
Swampscott Housing Authority
Swansea Housing Authority
Taunton Housing Authority
Templeton Housing Authority
Tewksbury Housing Authority
Topsfield Housing Authority
Tyngsborough Housing Authority
Upton Housing Authority
Uxbridge Housing Authority
West Boylston Housing Authority
West Bridgewater Housing Authority
West Brookfield Housing Authority
West Newbury Housing Authority
West Springfield Housing Authority
Wakefield Housing Authority
Walpole Housing Authority
Waltham Housing Authority
Ware Housing Authority
Wareham Housing Authority
Warren Housing Authority
Watertown Housing Authority
Wayland Housing Authority
Webster Housing Authority
Wellesley Housing Authority
Wenham Housing Authority
Westborough Housing Authority
Westfield Housing Authority
Westford Housing Authority
Westport Housing Authority
Weymouth Housing Authority
Whitman Housing Authority
Wilbraham Housing Authority
Williamstown Housing Authority
Wilmington Housing Authority
Winchendon Housing Authority
Winchester Housing Authority
Winthrop Housing Authority
Woburn Housing Authority
Worcester Housing Authority
Wrentham Housing Authority
Yarmouth Housing Authority
Berkshire County Housing Authority
Dukes County Housing Authority
Franklin County Housing Authority
Hampshire County Housing Authority
Name of Person Filling Out Waiver
(Required)
First
Last
Position of the Person Filling Out Waiver
(Required)
Email
(Required)
Date of Waiver Request
(Required)
MM
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
YYYY
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Type of Waiver Request
(Required)
Initial Waiver
Waiver Renewal
I am requesting a waiver on behalf of the above LHA because
(Required)
(Waiver 1) LHA board already has a Town elected appointee board member who is a member of a tenant household or rental assistance household
(Waiver 2) No person eligible and willing to serve as Tenant Board Member
Name of Board Member who is a tenant/rental assistance participant
(Required)
First
Last
Address of Board Member who is a tenant/rental assistance participant
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date that term of the seat occupied by that Board Member expires (end of 5-year term for which person was elected by Town or end of remainder of term if person was appointed by Town to fill vacant seat)
(Required)
MM
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
YYYY
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
I certify that the above Board Member is a tenant/participant
(Required)
Yes
No
Housing Program in which the tenant/participant is housed
(Required)
State-aided Public Housing
Federally Subsidized Public Housing
Section 8
AHVP
MRVP
I agree to notify the Town if the tenant is no longer a board member or is no longer a tenant
(Required)
Yes
No
Please upload statement of why waiver is being requested which must include: (a) Identification of any LTO(s) and their contact information; (b) Date/time of meeting with all LTO(s) with brief description of meeting contents; (c) Dates/locations of postings of all notices
(Required)
Drop files here or
Select files
Max. file size: 50 MB.
Please upload evidence of notices, which may include: (a) Copies of notices posted on the LHA web page and in the common areas of the LHA; (b) Copies of notices sent to all LHA households of tenants and rental assistance participants
(Required)
Drop files here or
Select files
Max. file size: 50 MB.
As of March 7, 2023, submissions of waiver requests must be accompanied by a Board vote approving the waiver request, please upload a copy of your Board Meeting Minutes.
(Required)
Drop files here or
Select files
Max. file size: 50 MB.
I understand that by law EOHLC may only grant this waiver for a one-year period, and that my LHA must repeat these outreach efforts before requesting any subsequent one-year wavier.
(Required)
Yes
If you have any questions or encounter any issues completing this form, please contact Jesenia Diaz at jesenia.diaz@mass.gov.