Housing Rehabilitation and Emergency Repair Grant Application

  • Housing Rehabilitation and Emergency Repair Grant Application

  • Date of Birth *
     - -
  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Rows
  • Are Property Taxes paid? (i.e. Town, County, School)*
  • Are you on an installment plan with the county?*
  • Is this your primary residence?*
  • Have you owned & occupied your home for one year or more?*
  • Do you have a current Homeowner's Insurance policy?*
  • Is this a single-family home?*
  • Is this a*
  • Do you own the land where your mobile home sits?*
  • Do you have a mortgage?*
  • Are mortgage payments current?*
  • Do you have any other liens on the property deed?*
  • Is the Deed in the applicant's name?*
  • If no, do you have a Life Use?
  • Is there a Land Contract on the property?
  • Do you have more than $15,000 in assets (checking, saving, IRA, 401K, CDs, etc.)?*
  • Are you related to any public official in the County in which you reside or to any officer or employee of NRDC?*
  • Rows
  • Rows

  • Statistical Data

  • Federal and State Law prohibits discrimination on the basis of age, sex, race and national or ethnic origin. North Country Rural Development Coalition is committed to serving its community without discrimination and will comply with all rules and regulations regarding Fair Housing, Equal Opportunity, and Minority and Small Business Participation. This data is for statistical purposes only and will not be considered by any local, State, or Federal official in determining applicant eligibility for assistance

  • Applicant

  • Are you a citizen of the U.S.?*
  • Ethnicity*
  • Race*
  • Are you a person with a physical disability?*
  • Are you a veteran?*
  • Are you a Medicaid recipient?*

  • Co-Applicant

  • Are you a citizen of the U.S.?
  • Ethnicity
  • Race
  • Are you a person with a physical disability?
  • Are you a veteran?
  • Are you a Medicaid recipient?

  • You have the option to upload additional documents that are needed to qualify you below. Please note that we have a long waitlist and you maybe required to submit updated documents again. 

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  • If there are children in the home, have any of these children been identified as having elevated lead blood levels?*
  • Do you have any current open building permits on your property?*
  • Have you previously done work or renovations on your home?*
  • If yes, have you obtained a CO with your local code enforcement officer to approve and sign off on this work?
  • Date of Work
     - -
  • Date of CO
     - -

  • All information provided will be kept confidential. All applications received will become the property of North Country Rural Development Coalition (NRDC). I (We) hereby apply for assistance from NRDC. I (We) certify that the above statements are true, accurate, and complete to the best of my (our) knowledge and belief. False statements made knowingly by the applicant will disqualify the applicant from participating in the program. I (We) hereby consent to and authorize NRDC to obtain verification of information required for compliance with the regulations of this program, including income, expenses and employment.

  • AUTHORIZATION TO SHARE/RELEASE INFORMATION: I am applying for, or seeking to obtain, a loan or grant from North Country Rural Development Coalition. As part of this process, NRDC may share information contained in my request for assistance and the documents required for eligibility in connection with other area agencies for the purpose of collaborating funds. I understand any rights which I (we) may have to the contrary, pursuant to the privacy act, are hereby expressly waived for this purpose.

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