Handyworker Program Interest Form

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THERE IS CURRENTLY A WAITLIST. Please carefully review our website for a description of the services provided. If you experience any difficulty with this form or have any questions, please contact our hotline at 213.808.8803.

Email *

Record my email address with my response

Primary Phone Number *

Full Name *

Property Address *

Zip Code *

Birth Date *

YYYY

Do you have a permanent disability? *

Yes

Estimated Annual Household Income for ALL Adults Living in the Home: *

$70,650 or below annually for 1 person

$80,750 or below annually for a family of 2

$90,850 or below annually for a family of 3

$100,900 or below annually for a family of 4

$109,000 or below annually for a family of 5

$117,050 or below annually for a family of 6

$125,150 or below annually for a family of 7

$133,200 or below annually for a family of 8

Check here if more than 8 people

Are you the property owner or a tenant in a single family home? *

Property owner/ tenant in a single family home

Property owner/ tenant in a multi family home

A copy of your responses will be emailed to .

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