Housing Rehab Wait List Application

Housing Authority of Yamhill County & Yamhill County Affordable Housing Corporation (YCAHC) Housing Rehabilitation Waiting List Application

135 NE Dunn Place, McMinnville, OR 97128 Phone: (503) 883-4324 Fax: (503) 472-4376
Name:*

First NameLast Name
Direct Phone Number:*

Area CodePhone Number
Physical Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Message Phone Number:
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total Household Members:
Age of Adults:*
Email Address:
example@example.com
Age of Children:*
Minor Children Currently living in the home:*
Are you...? (Check all That Apply)*

62 years of age or olderDisabledSingle ParentNone Apply
Have you ever served in the US Armed Services?*

YesNo
Head of Household Ethnicity:

HispanicNon-Hispanic
Race:
MONTHLY Total Household Gross Income:*
ANNUALLY Total Household Gross Income:*
Approximate year your home was built:*
Estimated assessed value of your home:
Estimated amount owed on your home:
Is your home a manufactured home?*

YesNo
If yes, do you own the land the home is on?

YesNo
Home repairs you need (describe the repair in detail):
Primary repair item:*
Siding:
Foundation:
Dry Rot:
Electrical:
Plumbing:
Roof/Gutters:
Septic/Sanitation:
Insulation:
Doors/Windows:
Special Needs:
Painting:
Structural:
Mechanical:
Flooring:
Other:
This information may be used to apply for funding from Federal, State, or Private Sources.

Equal Housing Opportunity
Should be Empty:

Housing Authority of Yamhill County & Yamhill County Affordable Housing Corporation (YCAHC) Housing Rehabilitation Waiting List Application