Thank you for your interest in the City of Monroe's Housing Rehabilitation Program. The Housing Rehabilitation Program is dedicated to "Building Strong Families and Healthy Neighborhoods" through federal Housing & Urban Development (HUD) funding and is designed to assist low to moderate-income families within our growing community. Please complete this survey to request more information about housing rehabilitation.

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* 1. First Name

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* 2. Last Name 

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* 3. Age

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* 4. Email Address

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* 5. Phone Number

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* 6. Preferred method of contact 

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* 7. Street Address

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* 8. City

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* 9. State

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* 10. Zip Code 

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* 11. Are you the legal homeowner of this property? 

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* 12. Please describe the problems you are experiencing in your home. (Electrical or Plumbing Issues, Dilapidated Roofing, Storm Damages, etc)

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* 13. Please indicate your annual household Income.

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* 14. Please list the name and ages of persons living within your household. Separate name and age with "/". 

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* 15. Are you or someone within your home disabled? 

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* 16. Have you or anyone in your household been affected by COVID-19?

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* 17. If yes, please explain how below:

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* 18. Are you a veteran?

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