House in Need Updated Form: 2015
We are updating our records and need the following information completed.
Basic Information:
Name *
Your answer
Resident Affected Address *
Your answer
Town *
Your answer
Telephone # *
Your answer
Email Address *
Your answer
Current Address
(if different than above)
Your answer
Where you are now? 2015
If you are back in your home and feel comfortable in your situation, that is wonderful and you do not have to complete the rest of this form. We will update your first application as complete.
Are you living at premises affected by Super Storm Sandy
Which rooms are still not completed?
How long do you think repairs will take?
Your answer
Are you lifting your home?
Do you need mold remediation?
Do you need help budgeting/planning the rebuilding of your home?
Are you interested in selling?
Would you like a CMA to contact you with a recommendation regarding refinancing options.
Do you need any Demolition work completed?
If you answered Yes to Demolition work, Please give us a brief description of what needs to be done.
Your answer
Do you have neighbors not living back at home who need help with lawn care? If so, please give us their address.
We may have a group to mow lawns around town to help with your streets curb appeal
Your answer
Are you stuck in the rebuilding stage because you have ran out of funds completely?
There is no more insurance/FEMA money left. You may comment below if needed.
Your answer
What appliances have you not purchased yet?
Would you like to be contacted by someone for emotional support?
e.g. Project Hope, Support Groups in your area
Are you in need of furniture at this PRESENT time?
If you responded Yes to previous furniture question, please provide a Brief description of what is needed or what rooms need furniture too.
Your answer
Did you apply for NY Rising Grant?
Have you been assigned a NY Rising caseworker?, and/or Schedule an Appointment?
Besides previous questions....What do you feel that you need assistance with at the present time?
Your answer
Comments, Suggestions, and Concerns?
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy