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Pre-Screening Intake Application for Housing Rehabilitation

  1. Marital Status*

  2. Do you have a mortgage?*

  3. Is it current?*

  4. Property Taxes and Insurance Current?*

  5. Any liens against property?*

  6. Foreclosure in the past 2 - 3 years?*

  7. Any Collections or Judgments?*

  8. Bankruptcy in past 2 - 3 years?*

  9. Was home included in bankruptcy?*

  10. Once you have completed the form, you may select "Receive an email copy of this form" to send yourself a copy of the form in email, then Submit or Submit and Print. If you select Submit and Print, when the screen appears, right-click and select Print. The form will be automatically routed to your printer.

  11. Leave This Blank:

  12. This field is not part of the form submission.