Homeowner Repair Grant Application
Homeowner Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you live in this property full-time?
*
Yes
No
Do you own the home?
*
Yes
No
Household Info
Number of people in household
*
Total annual income
*
Do you fall between 90-120% AMI?
*
Yes
No
Not Sure
Repairs Needed
What type of repairs do you need?
*
Roof
Siding
Foundation
Code Violations
Emergency Repairs (plumbing, electrical, heat)
Other
Brief description of issues
*
Upload photos if available
Browse Files
Drag and drop files here
Choose a file
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of
Documentation
Most recent two years of tax returns
*
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of
Proof of ownership (deed or mortgage statement)
*
Browse Files
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of
Photo ID (Optional)
Browse Files
Drag and drop files here
Choose a file
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of
Final Steps
Consent Checkbox
*
I understand this is a pre-application and does not guarantee funding.
Submit
Should be Empty: