Tenants and Residents Request to Add a Household Member 18 Years and Older

Rocky Mount Housing Logo.

1065 Pinehurst Drive | PO Box 4717 | Rocky Mount, NC 27803
Phone: 252.977.3141
Fax: 252.977.2587
Emergency After-Hours: 252.977.6223
Office Hours: Monday - Friday | 8:30 am - 5:00 pm

Equal housing, handicap accessible, and ADA logos.

Fields marked with * must be filled out or form will not submit.

Anyone you list as a household member (18 Years and Older) must use the subsidized unit as their primary residence (at least 51% of the time). All adults must have an acceptable criminal background, cannot owe any housing authority money, and, if s/he previously participated in a federally subsidized housing program, must have acceptable compliance history. All adult additions must be approved in writing by your landlord and by Rocky Mount Housing before the additional person can move in.

Note: The fields at the bottom of this form marked "For Landlord Use Only" and "For RMHA Use Only" should not be completed when submitting this form.