SCACAP Housing Rehab Pre-Application
What Do I Need to Apply?
A Valid, Government-Issued Photo I.D. for the Applicant
Valid proof of government-issued ID for all in the home (State license, birth certificate, or social security card, etc)
Proof of Home Ownership (copy of the deed, property tax bill, etc.)
For renters, Proof of lease
Proof of Total Household Income (pay stubs, previous year tax return, W-2, 1099, etc.)
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General Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Cou
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County:
Emergency Contact
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Relationship
Household Information
Are there others that reside in the home?
Yes
No
1. Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
If 18 or older, are they employed?
Yes
No
2. Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
If 18 or older, are they employed?
Yes
No
3. Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
If 18 or older, are they employed?
Yes
No
Home Information
Income Information
Employment Status:
Employed
Unemployed
Are you receiving other sources of income such as alimony, child support, social security, etc?
Yes
No
Please list those other sources below:
Estimated household income
Property Information
Own/Rent
Home Owner
Rent
Name
Phone Number
Please enter a valid phone number.
Company Name
Rental Amount
Type of property:
Single Family
Duplex
Manufactured
Other
How long have you lived in the home?
What year was the home built?
Square Footage:
Please select all that may apply to in-home needs
Damp/ Mold Growth
Volatile Organic Compounds
Lighting
Food Safety
Falls associated with Baths etc.
Falling Between Levels
Flames, Hot Surfaces, etc.
Excess Cold
Biocides
Radiation
Crowding and Space
Noise
Personal Hygiene, Sanitation & Drainage
Falling on Level Surfaces
Electrical Hazards
Collision and Entrapment
Structural Collapse and Falling Elements
Excess Heat
Carbon monoxide/ fuel combustion products
Non-Combusted Fuel Gas
Entry by Intruders
Domestic hygiene, Pest/ Refuse
Water Supply
Falling on Stairs etc.
Fire
Explosions
Verification Items Upload
ID Verification (A Valid, Government-Issued Photo I.D. for the Applicant)
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Proof of Ownership or Lease (copy of the deed, property tax bill, etc.)
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Proof of Total Household Income (pay stubs, previous year tax return, W-2, 1099, etc.)
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Submit
Should be Empty: