Snow Belt Housing
Property Rehabilitation Pre-Application
Please enter a valid phone number.
Street Address Line 2
Postal / Zip Code
Have you owned and lived in the home for at least (1) year?
Do you have a valid deed for the property?
Do you currently have a mortgage?
Do you currently have homeowner's insurance?
Have you ever used grant funds to repair your home in the past?
If yes, what was repaired and when?
Names of all household members that contribute to income:
Source of income for each household member:
Total monthly income for each tenant:
What is the total yearly income for everyone in the household?
How many people live in the household?
Is anyone age 60 or over?
Is anyone disabled?
Is anyone handicapped?
Are you a single parent with children aged 18 or younger?
Are you a female head of household?
Please check the boxes for the repairs that may be needed:
If other, please list here:
Should be Empty:
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