Blueprint15 Rental Repair Program Application

Blueprint 15

Rental Repair Pilot Program
2022 Rental Repair Pilot Program
This past year, Blueprint15 conducted neighborhood research and found that there was demand for funding to rehabilitate small rental properties in our targeted neighborhood. In response, Blueprint15 created a Rental Repair Pilot program for small “Mom and Pop” landlords who live within our service footprint. The Rental Repair program provides a matching grant of up to $10,000 per unit (for 1-3 family properties) for any type of health and/or safety repairs such as replacing doors, windows, siding, porches, furnaces, hot water tanks and more. Please note that this grant must be matched with landlord funding (cash and/or bank or Home HeadQuarters’ home improvement financing). Rental property cannot be seizable due to tax delinquency and must be occupied. If you have any questions regarding this program, please email us at info@blueprint15.org or call us at (315) 418-4676.
Who told you about this program?

Home HeadQuarters Door to door outreach Letter mailed to me Other
What would you liked repaired? (Check all that applies)

Doors Windows Steps Painting Gutters Other
Applicant Name
Co-Applicant Name (if applicable)
Preferred phone number
Secondary phone number (optional)
Email Address
example@example.com
Rental Property Address (the property you are applying for)

Address (Street Number and Name)

Street Address Line 2

City or Town State

Zip
Is the above property your primary residence?

Yes No
If no, please provide your primary residence (if applicable)

Address (Street Number and Name)

Street Address Line 2

City or Town State

Zip
Is this considered a rental property?

Yes No
Type of property (please check one)

1 family 2 family 3 family
Demographic Information
You are not required to furnish this information, but are encouraged to do so. Blueprint15 will not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not wish to furnish this information, please check the box below.
Applicant

I do not wish to furnish this information
Co-Applicant

I do not wish to furnish this information
Ethnicity

Hispanic or Latino Not Hispanic or Latino
Co-Applicant Ethnicity

Hispanic or Latino Not Hispanic or Latino
Race

White Asian American Black or African American Asian American Native Hawaiian or Other Pacific Islander American Indian, Alaskan Native Other
Co-Applicant Race

White Asian American Black or African American Asian American Native Hawaiian or Other Pacific Islander American Indian, Alaskan Native Other
Gender

Male Female Other
Co-Applicant Gender

Male Female Other
MATCH FUNDING
How are you planning to provide your one-to-one match funds?

I have a cash match I plan on applying to Home HeadQuarters Small Business Loan I'm not sure. I would like someone from your office to contact me Other
If you are planning on applying for financial assistance you can contact HHQ by emailing info@homehq.org or calling 315-474-1939 and asking about matching financing for the Blueprint 15 Rental Repair Pilot Program.
Please select one of the following:

I have a valid Rental Registry for this property I have a Rental Registry application pending with the City of Syracuse Other
REQUIRED DOCUMENTS
You are required to provide the following documents:

Proof of ownership (i.e. copy of deed) Copy of your current Homeowners Insurance Photo ID
Please upload required documents here or email them to info@blueprint15.org

Cancel of
IMPORTANT - PLEASE READ BEFORE SIGNING
All statements made in this application are true and are made for the purpose of requesting home improvement service. I/We understand that it may be a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of the US criminal code. I/We also authorize Blueprint15 Inc. to verify any information contained in this application with other parties and to report its transactions with me. I/We authorize Blueprint15 to share information I/we have provided on this application and any other information relevant to my/our home improvement service with any of the Program partners. I/We understand that Blueprint15, its agents and/or assignees reserves the right to inspect any and all work associated with the home improvement grant or any other financial product or service. I/We understand that this application in no way guarantees or implies funding and/or service through Blueprint15, its agents and/or assignees.
Signature of Applicant

Clear
Signature of Co-Applicant

Clear
Date

Month Day Year
Date
Date

Month Day Year
Date
100 New Street, Syracuse, NY 13204 | (315) 418-4676 | www.blueprint15.org
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Blueprint 15

2022 Rental Repair Pilot Program

Demographic Information

MATCH FUNDING

REQUIRED DOCUMENTS

IMPORTANT - PLEASE READ BEFORE SIGNING