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Neighbors Helping Neighbors

2. First Name*

3. Last Name*

5. Address*

7. City*

8. State*

9. Zip Code*

11. Phone Number*

12. Email Address

14. Annual Gross Income

    List Sources and Amounts

16. Total Annual Gross Income*

    Total amount from above

17. Your Age

19. Number of people living in your house*

20. How many years have you lived in the residence above?*

22. Are you currently receiving Social Security for age or disability?*

    1. Yes
    2. No
24. Have you been granted City assistance before?*

    1. Yes
    2. No

25. If you have received City Assistance before, when?

27. Are you completing this application to help resolve a code enforcement issue?*

    1. yes
    2. no

29. Please provide a description of the work you would like done through this program.*

    *Note: Only exterior renovations, including ADA improvements are eligible.

31. Optional - upload photos of existing residential improvements to be completed.

33. Image 1

34. Image 2

35. Image 3

36. Image 4

38. Additional Information May Be Required
    Please note, prior to receiving assistance through the Neighbors Helping Neighbors program, the applicant will be required to sign a certification verifying that you agree to the terms and conditions of the program, as well as a liability waiver. This form is available on our website and can be uploaded as part of this online application.

    Please note, prior to receiving assistance through the Neighbors Helping Neighbors program, the applicant will be required to sign a certification verifying that you agree to the terms and conditions of the program, as well as a liability waiver. This form is available on our website and can be uploaded as part of this online application.

40. Applicant Certification and Home Owner's Agreement and Release from Liability

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field