Region 6 Housing Trust Fund: Housing Assistance Pre-Application
Contact Information
Name of Applicant(s)/Homeowner(s)
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Street Address
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City, State, Zip
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Telephone
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Email
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Home Damages
HOME DAMAGES: Please check the boxes that apply to your home damages below.
Please provide any other details about your home damage. Help us understand the extent of damage to your home.
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Household Information
Number of People Living in Home
Estimated Annual Income
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Sources of Income (ie: name of employer, social security, pension, disability, etc.)
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How is your home being purchased?
Insurance Information
Do you have insurance on your home?
If you have insurance, what damages are covered by insurance?
Your answer
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