Home Preservation Program
Phase 1 - Initial Application
Name
*
First Name
Last Name
Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
What is your preferred language?
Do you live in Montezuma County?
*
Yes
No
Do you own and live in your home?
*
Yes
No
Does your home need critical exterior repairs such as: windows, doors, gutters, downspouts, siding and trim, fences, wheelchair ramp, or roof?
*
Yes
No
Are you current on ALL mortgage payments and property taxes?
*
Yes
No
Do you currently have an active homeowner's insurance policy?
*
Yes
No
Has your home previously been repaired by Habitat Montezuma?
*
Yes
No
Is your gross monthly income between 30% and 80% AMI? (Please see chart below)
*
Yes
No
How did you hear about the program?
*
Informational Session
Friends and/or Family
Community Event
Other Organization
Government Agency
Social Media
I am a Habitat Volunteer
Habitat Montezuma Website
Habitat Newsletter or email
School
Place of Worship
Other
Submit
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