Whole Home Repair Program Interest Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Pennsylvania has some of the oldest housing stock in the nation. Hundreds of thousands of homes across the Commonwealth have moderate to severe physical inadequacies, including leaky roofs or windows, blown fuses or exposed wiring, unreliable heat, or the lack of a flushing toilet. As people struggle to simply hold on to their homes, they may be forced to forgo regular maintenance and small repairs and upgrades, deferring until a repair is more urgently needed, and more expensive.

The Whole Home Repair Program is the first of its kind in the nation, making it so that Pennsylvanians can stay warm, safe, and dry in homes they can afford. Homeowners who make 80% of the Area Median Income (AMI) may be eligible to receive funding up to $50,000 to repair, update, and adapt their home.

Please complete the following form to indicate your interest in participating in the Whole Home Repair Program.

What is your name? *

What is your phone number? *

Do you have an alternate phone number? If so please include.

What is your email address? *

What is your full address? (Example: 123 Main Street Citytown, PA 12345) *

Please briefly describe the repairs you would like considered for your home. (Example: replace broken windows, repair leaky roof, repair or replace furnace, etc.) *

How many people live in your home? *

Based on the number of people noted above, is your income LESS than the amount in Column B below? *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms