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House in Need Updated Form: 2015
We are updating our records and need the following information completed.
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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
YES
NO
Clear selection
Which rooms are still not completed?
Entire residence
Kitchen
Bathroom
Bedroom/s
Basement
Living room
Dining room
done
How long do you think repairs will take?
Your answer
Are you lifting your home?
Yes, Completed already
Yes, We have a date set
Yes, but we do not know when
No, it wont be possible due to funds
No
Clear selection
Do you need mold remediation?
Yes, I would like to be contacted by a company who can help.
Yes, I am finding a company to complete
No, Mold remediation was already completed
Clear selection
Do you need help budgeting/planning the rebuilding of your home?
Yes
No
Clear selection
Are you interested in selling?
Yes
No
Clear selection
Would you like a CMA to contact you with a recommendation regarding refinancing options.
Yes
No
Clear selection
Do you need any Demolition work completed?
Yes
No
Clear selection
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.
Yes
No
Clear selection
Your answer
What appliances have you not purchased yet?
I do not need any appliances
Stove
Refrigerator
Microwave
Dishwasher
Dryer
Washing Machine
Would you like to be contacted by someone for emotional support?
e.g. Project Hope, Support Groups in your area
Yes
No
Clear selection
Are you in need of furniture at this PRESENT time?
Yes
No
Clear selection
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?
Yes
No
Clear selection
Have you been assigned a NY Rising caseworker?, and/or Schedule an Appointment?
Yes
No
Clear selection
Besides previous questions....What do you feel that you need assistance with at the present time?
Your answer
Comments, Suggestions, and Concerns?
Your answer
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