REPAH Application Form

Name*

Email*

Phone #*

Are you disabled? Answer yes or no.

Physical address requring repairs:*

Do you own this property? Answer yes or no.*

Condition of dwelling? Answer good, fair, poor, or describe.

Number of people in household?

Annual Income?

How did you find out about REPAH?

Are you able to do any of these repairs yourself? If so, what is the projected costs of materials?

Click here to attach photos

Attachments (0)

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When you click send, your application will be sent to a REPAH representative, who will reach out to within 48 hours.

Download Printable Application

REPAH APP (pdf)Download

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