Home Repair Program Eligibility Questionnaire

Reasons you do not qualify:
PLEASE NOTE:
This is a preliminary questionnaire and NOT an application.
If you meet pre-qualifications, you will receive an email with instructions on next steps to complete an actual application.
Home Repair Program Eligibility Questionnaire
Name*

First NameLast Name
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
What is your preferred language?*

EnglishSpanishFrenchOther
Do you live in one of our service areas highlighted on the map? Globeville, Elyria- Swansea, North Park Hill, East Colfax or Southwest Denver ( See the map below)?*

YesNo
Do you own and live in the home in the highlighted area?*

YesNo
Do you own a single-family home or a townhome?*

YesNo
Does your home need critical exterior repairs such as: windows, doors, gutters, downspouts, siding and trim, fences, wheelchair ramp, or roof?*

YesNo
Are you current on ALL mortgage payments and property taxes?*

YesNo
Do you currently have an active homeowner’s insurance policy?*

YesNo
Is your monthly household income within our income guidelines? (Please see chart below.)*

YesNo