Program-Sorting Intake Form

Home Repair Intake Application

This form is the first step in determining if a property qualifies for a forgivable home repair loan. These programs are funded by the State of Rhode Island and City of Providence through the American Rescue Plan Act. If you need assistance filling this out or would prefer to do so in person, please call us at (401)272-2760.
Property Owner Name*

First NameLast Name
In what city is the property?*
These cities contain Qualified Census Tracts (QCT). If your property is in Providence or a QCT, you may qualify for a forgivable loan through the State of Rhode Island or the City of Providence.
Have you been cited by the city for a code violation?

YesNo
City of Providence Code Violation

Please upload your city code violation here. If you do not upload it here, we can collect it during the next steps of eligibility determination.
Cancelof
This property does not qualify for our current forgivable home repair loan programs.

This property is not in a city with Qualified Census Tracts, nor is it in Providence, meaning it would not qualify for the State or City's forgivable loan programs. However, if you want to submit your information to PRF, we will update you in the event of a new home repair program for which this property may qualify.
Email*
For receiving updates, follow-up forms, and a copy of what you submit here.
Contact Phone Number*
Please enter a valid phone number at which we can reach you.
Full Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please give a brief description of the repairs needed for this property*
Property Type*

Single FamilyMulti Family
In what year did you buy the property?*
If you aren't sure, an estimate is fine.
Does the owner live at this property?*

YesNo
Total number of residential units*
Including owner's unit, if owner lives on property.
This property does not qualify for our current home repair loan programs.

This property has more than 4 units, which means it is considered a commercial property.
Resident Name*

First NameLast Name
Owner's Estimated Annual Household Income
PRF will need documents to verify this income in the next stage of qualification, but an initial estimate can help us determine which program is right for this property.
Household Size*
Total number of people that live on the single-family property or people living in the property owner's unit.
Household income limit is {incomeLimit}

Because this property is in {inWhat}, and its household size is {householdSize}, the annual household income limit to qualify for a forgivable loan program is {incomeLimit}.

{additionalQct}
Select all programs for which you have previously applied or been approved:

CAPP Weatherization ProgramCAPP Lead Safe Providence ProgramCAPP Low Income Home Energy Assistance Program (LIHEAP)City of Providence Home Repair ProgramGHHI Healthy Providence ProgramHabitat for Humanity Home Modification Grant ProgramRhode Island Livable Homes Modification Grant ProgramOther
Do you authorize Providence Revolving Fund to reach out to other agencies whose programs you've already applied to collect your eligibility information?

YesNo
What is your preferred communication method?
This will determine how PRF reaches out to you with updates or requests for more information.
How did you hear about this program?
Ex. News coverage, word of mouth, green PRF sign on property, housing organization
Upon submitting this form, PRF will automatically check that the property is in a Qualified Census Tract (QCT) and email you the result.

If the property's address qualifies, PRF will review your application and follow up with you via your preferred method of communication to start the income qualification process.

If the address is not within a QCT, or if its residents are over the income limit for this program, it may still be eligible for other loan opportunities from PRF.
This property is within a Qualified Census Tract. When you submit this form, PRF will review your application and follow up with you via your preferred method of communication to talk about the income qualification process.

Verified household income will determine whether the property qualifies for a forgivable loan. However, even if this property is over the income limit for this program, you may still be eligible for a low interest loan from PRF.
Income Limit Calculation for Household and City
Additional QCT disclaimer
Was this form filled out by a partner organization?

YesNo
Partner Organization Name
The name of the organization assisting the applicant.
Language
This form's automations use the HUD User Data API but its use is not endorsed or certified by HUD User.
Should be Empty:

Home Repair Intake Application

This property does not qualify for our current forgivable home repair loan programs.

This property does not qualify for our current home repair loan programs.