Targeted Home Improvement Program (T-HIP)
Pre-Screening Form
Applicant Information
First Name
Last Name
Phone Number:
Email Address
Address
Street Address:
City
State
Zip code
Are you the legal owner of a 1 to 4-unit residential property located within the municipal boundaries of the Village of Hempstead?
Yes
No
Is this property your primary and permanent residence?
Yes
No
Does your total household income not exceed 80% of the Area Median Income (AMI) as per HUD’s income limits? Use the chart below for reference.
Yes
No
Are you current on all property taxes for the above-mentioned property?
Yes
No
Do you have comprehensive homeowner’s insurance effective at the time of award?
Yes
No
Applicant Certification
I certify that all the information provided in this form is true and accurate to the best of my knowledge. I understand that providing false information may result in disqualification from the Targeted Home Improvement Program.
Signature:
Date
Contact Information