****The Pre-Application Period for the Uniontown Homeowners Rehabilitation Assistance Program (UHRAP) is closed for this year. You may still fill out this Pre-Application for other programs that are available.****
Housing Rehabilitation Pre-Application
This pre-application will determine if you are eligible for the waitlist.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are the issues with your home? (ex. Roof and windows need replaced, issues with electric, furnace needs replaced... etc.)
*
Do you have reason to believe your home is located in a flood plain?
*
Yes
No
I do not know
Do you have lead issues in your home?
*
Yes
No
I do not know
Was your home built before 1960?
*
Yes
No
I don't know
Have you received a code violation/sweep violation notice?
*
Yes
No
Is the head of household or other member a veteran?
*
Yes
No
Is the head of household or other member disabled?
*
Yes
No
Racial Characteristics of Family:
*
White Caucasian
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Hispanic
Not Hispanic
Is the head of household or other member over the age of 62?
*
Yes
No
Home Status
*
Own
Rent
Rent to Own
Are mortgages recorded against your property?
*
Yes
No
I don't know.
How many mortgages have you had?
1
2
3
4
How many people live in the household?
*
If any children reside in the household part time, please list the average number of days per month the child lives in the home.
Are there children under the age of 2 in the home?
*
Yes
No
What is your total household income?
*
Include wages/salaries, benefits/pension, public assistance and any other income.
Do you have delinquent student loans?
*
Yes
No
Have you filed for bankruptcy?
*
Yes
No
Has it been discharged for at least 3 years?
Yes
No
I don't know
Have you ever received USDA 504 Funds?
*
Yes
No
I don't know
Have you ever received Weatherization Funds?
*
Yes
No
I don't know
Do you receive SNAP?
*
Yes
No
I don't know
Do you receive LIHEAP?
*
Yes
No
I don't know
Do you need modifications to your home due to medical/accessibility issues?
*
Yes
No
Do you have insurance that would cover the costs of these modifications?
*
Yes
No
Unsure
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I understand that under Title 18, Section 1001 of the U.S. Code "a person is guilty of a Felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government.
*
Questions, comments and/or concerns
Submit
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