Withdrawal Form

Withdrawal Form

  • This form serves as official notice of voluntary withdrawal from the Baltimore Housing Mobility Program, which is administered by the Baltimore Regional Housing Partnership. By completing this form, I acknowledge that all Program benefits and services will end on the effective date listed. I may reapply in the future, without penalty, if the Program is accepting applications.

  • Head of Household

    Fill in the information for the Head of Household

  • Write in the date you plan to leave the assisted unit.
    MM slash DD slash YYYY
  • The family must notify the owner of the assisted unit of their plans to vacate. Please provide the date the notification was completed.
    MM slash DD slash YYYY
  • Use this space to tell us why you are ending your participation in the program.
  • MM slash DD slash YYYY

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