People Helping People of Pinellas Park Homeowner ApplicationAll personal information is required and CONFIDENTIAL.All qualifying applicants MUST meet eligibility requirements. Go back Your message has been sent Name of Homeowner(s):(required) Warning Age(required) Warning Address(required) Warning Phone(required) Warning May we text you at this number?(required) Yes No Warning Email(required) Warning What type of Repair/Service(required) Warning Do you own your home(required) Yes No Warning Is this property insured?(required) Yes No Warning Is this property in foreclosure?(required) Yes No Warning Do you own any other properties? Yes No Warning List all persons 18 years of age and older residing in the household and their monthly income: Warning List all persons 18 years of age or older in the home that are full-time students? Warning Are there any members of the household, physically able to help with the project?(required) Yes No Warning Please list the names and phone numbers of relatives or friends who will help:(required) Warning Monthly Household IncomeEmployment Income $ Warning Rental Income $ Warning Social Security $ Warning Unemployment $ Warning Retirement/Annuity $ Warning Disability $ Warning Supplemental Social Security $ Warning Child Support $ Warning Total of Above Monthly Income: $ Warning If selected, are you willing and able to contribute ANY monies or materials to assist with the project? Yes – Money, amount $ No – Money Yes – Materials No – Materials Warning If so, what will be supplied: Warning Name of person completing the application:(required) Warning Date:(required) Warning Warning. SubmitSubmitting form
