COS Housing Rehab Quick Screen

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Quick Screening Guide

2024 Home Repair Funding

STEP ONE

Los formularios se pueden proporcionar en Espanol a pedido.

* Client Name

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* Do you own the home you are applying for repair assistance?

Yes

* Do you reside in this home full-time?

Yes

* The total number of people living in our household is:

8 or more

* Our TOTAL HOUSEHOLD Income is under

$50,750

$58,000

$65,250

$72,500

$78,300

$84,100

$89,900

$95,700 or more

* Where is the property located?

Inside the City of Statesville limits

Inside the Town of Mooresville limits

Other

Street address of home for address verification:

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* Does a disabled individual currently reside in the home as a full-time resident?

Yes

* Does a veteran currently reside in the home as a full-time resident?

Yes

* Does a elderly individual (62 or more years) currently reside in the home as a full-time resident?

Yes

* Is this a single-parent household with children (under 18) currently residing in the home as a full-time resident?

Yes

* My household has applied for past housing repair help in the last two years with the below agencies

None

Habitat for Humanity of Central Carolina

I-CARE

Rebuilding Together

Other

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* To your knowledge, what needs to be fixed to make the property safe and habitable?

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* I acknowledge that I have been informed of the following items:

Should this quick screen application be approved, an appointment will need to be set and a full application for assistance completed. This will require income verification documents, and a complete home assessment.

To fully comply with the rules and regulations required by many of our funding sources requires a signifigant investment of time. The full process is likely to take several months before repairs can begin.

Completing the application does not guarantee the project will be selected for assistance or that funding will be available to meet this need.

* Please type your name as acknowledgment that you have reviewed the items above and been informed of the full process.

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* Contact phone number

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Contact email

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Submit Survey

United Way of Iredell County | PO Box 1312 305 North Center St. | Statesville, NC 28687 US

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