Repair Program: Homeowner Intake Form


Please complete this form with as much requested information as possible. Please note that we are currently accepting applications for homeowners located in White Center, Skyway, and Glendale areas. Applications are temporarily closed for all other services areas at this time. We anticipate applications will re-open for all service areas in mid to late July 2025.


If applications are closed for your area, we encourage you to check back with us starting mid July to confirm if applications have re-opened.

 

First and Last Names

 

She/her, He/him, They/them, Other

 
 
 
 
 
mm/dd/yyyy
 

Please enter entire street address

 
 
 
Phone
 
 
 

Please describe the repair(s) needed

 
 
Drop your files here
 

Please estimate your gross household income per month or per year.

 

Please click total number of people in household

 
 

Click if you or a member of your household is a veteran

 

Please click if you or a member of your household is disabled

 

Please select number of residents in your household that are 62 years or older on today's date.

 

Please select all that apply.

 
 

Enter 0 if you do not have a mortgage

 

Enter 0 if you do not have a mortgage

 

Please check if you have homeowners insurance

 

Please indicate if the desired repair is to be performed on a manufactured home.

 

Check if you have a reverse mortgage

 
 

Use drop down or enter name

 

Please click on the arrow to select and option, or enter one if your option is not listed.

 

Please enter any other repair programs you have applied to.