Home Repairs Program Application

Home Repair Inquiry Form
Eligibility Criteria

To be eligible for GRDC home repair programs, you must meet certain criteria, including but not limited to:
- Residing within the Grandmont Rosedale service area (Grandmont, Grandmont No.1, Minock Park, North Rosedale Park, Rosedale Park).
Note: Grandmont Rosedale Development Corporation conducts home repairs based on a waitlist as funding permits. This is not a guarantee of service. Applicants will automatically be added to a waitlist.
Name*

First NameLast Name
What is your age range?

18-3536-5455 and up
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Do you currently have fully functional utility (heat, electric and water)

YesNo
Total number of people living in your household*

12345Other
Do you have any children aged 6 or under?

YesNo
What is your annual gross (pre-tax) household income*
Select all that best describe your repair needs*

Roof and/or GutterWater damageSewageMold and/or rottingWalkwaysWindowAC/HeatingWater heaterStairwellsElectricalOther
When did you find out the repair was need

Less than a week agoLess than a month agoMore than three months ago
How did you hear about us?*

WebsiteGRDC newsletterSocial Media (Facebook, Instagram)Word of MouthReferral
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Home Repair Inquiry Form