Create your online account.

Please enter a username, password, and e-mail address to create an account. This is necessary to save your pre-application and will allow you to return later to complete it if necessary. Your password must consist of at least 8 characters, and contain at least one number and one upper case letter.

Choose a username:

Enter your e-mail address:

Choose a password

Confirm your password

To Begin Your Application

Please fill in the form below with the person who will be the Head of Household.

First Name

Middle Initial

Last Name

Birth Date

Social Security Number

Alien Registration Number

*Include leading A

Street Address

City

State

Zip

Phone

Gender

Male Female

Ethnicity

Race

Emergency Contact Information

Emergency Contact First Name

Emergency Contact Last Name

Phone

Street Address

City

State

Zip

Are you now or have you ever been a resident of the City of Erie?

Yes No

Is the Head of Household or spouse currently employed?

Yes No

Citizenship

USA Citizen Eligible Non-Citizen

Are you disabled?

Yes No

Are you 62 or older?

Yes No

Do you or anyone in your household that is over 18 have a criminal record?

Yes No

If yes, in what city and state?

If yes, please describe