Region 6 Housing Trust Fund: Housing Assistance Pre-Application
Name of Applicant(s)/Homeowner(s)
City, State, Zip
HOME DAMAGES: Please check the boxes that apply to your home damages below.
Missing shingles on roof
Hole in roof or missing area of roof
Damage to chimney
Damage to siding
Damage to brick
Damage to fascia
Damage to soffit
My home is structurally compromised
Please provide any other details about your home damage. Help us understand the extent of damage to your home.
Number of People Living in Home
8 or more
Estimated Annual Income
Sources of Income (ie: name of employer, social security, pension, disability, etc.)
How is your home being purchased?
I own the house outright
I have a mortgage through a bank
I have a rent-to-own contract sale on the house
Do you have insurance on your home?
If you have insurance, what damages are covered by insurance?
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