TANGIPAHOA PARISH GOVERNMENT PRELIMINARY APPLICATION - REQUEST FOR ELEVATION ASSISTANCE
This is only a preliminary application and does not constitute a guarantee that funding will be provided or that a grant will be approved.
APPLICANT INFORMATION
First Name
Your answer
Last Name
Your answer
Home Telephone #
(***)***-****
Your answer
Other Telephone #
Your answer
Applicant email address
Your answer
PHYSICAL STREET ADDRESS of property that has been flooded:
Street Number
Your answer
Street Name
Your answer
City
Your answer
Zip Code
Your answer
Mailing Address (If different from Physical Address)
Street Number
Your answer
Street Name
Your answer
City
Your answer
Zip Code
Your answer
Household Information
If there is a Co-Applicant/Spouse, provide First & Last Name
Your answer
Total Number of Household Members Residing in Unit
Your answer
Past Flood Damage Information
Estimated date that your home or structure was flooded for the 1st time?
MM
/
DD
/
YYYY
Estimated Value of Damage in Total Dollars($)
Your answer
Estimated date that your home or structure was flooded for the 2nd time?
MM
/
DD
/
YYYY
Estimated Value of Damage in Total Dollars($)
Your answer
Estimated date that your home or structure was flooded for the 3rd time?
MM
/
DD
/
YYYY
Estimated Value of Damage in Total Dollars($)
Your answer
Please respond to the questions below:
Are you presently occupying the house or building being applied for?
Do you have flood insurance?
Do you have an elevation certificate?
Do you have photos/pictures of the house or building you want to elevate?
Year of Construction
Your answer
Estimated square footage of the building-house:
Your answer
How many stories tall is the primary structure?
Is the house or building on a slab or elevated on footings/piers?
I UNDERSTAND that my application will be processed on a first-come, first-serve basis, depending upon funding available, the property owner match available, and the completeness of the application. I CERTIFY that all of the information that I have provided is true and correct to the best of my knowledge. I FULLY UNDERSTAND that if I provide any false or misleading information, my application will be disqualified.
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