Housing Preservation Loan Program Questionnaire Form

NeighborImpact Home Preservation Loan Program Questionnaire

Tell us about your home
Do you own your home and the land beneath it, with a mortgage or paid in full?*

YesNo
What year was your home built?*
What is the age of the head of household?
What is the combined gross annual income of the household?
*If your gross annual income is above what is shown in the Annual Income Limit Table you are not eligible for the home preservation loan program and should contact your bank or credit union for financing options.
County:

CrookDeschutesJefferson
Is the home a manufactured home?*

YesNo
Is the home located in a Mobile Home Park?*

YesNo
Is the home your primary residence?*

YesNo
For how long?*
Are you current with your property taxes?*

YesNo
Do you have any liens on the property? Taxes, home equity loan?*

NoYes
Do you have a reverse mortgage?*

NoYes
*If you have a reverse mortgage you are not eligible for our home preservation loan program and should contact your lender.
What county do you reside in?*

CrookDeschutesJefferson
Are you within city limits?*

YesNo
What types of repairs does your home need? Check all that apply*

Health and safety improvementsMobility, disability or accessibility modificationsSeptic replacementSewer line connectionsDrain field repairs or installationPrivate water linesHouse structural repairs, including roof repair/replacementRepair/replacement of substandard plumbing, electrical, siding, heating systems, hot water heaters, and other related activitiesWindows or doorsEnvironmental hazard abatement, including asbestos removal, lead paint removal and mold/dry rot repairOther: please specify
Does anyone in the home have a disability or mobility impairment?*

YesNo
How many people live in the household?*
Is the home currently listed for sale or has it been listed in the last 6 months?*

YesNo
Please provide your contact information so that we can follow up with you with more information. We receive a large number of requests for this program and will make every attempt to contact you in the order your inquiry was made.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you a veteran?*

YesNoActive military
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please contact us by email at lending@neighborimpact.org to discuss your options
Should be Empty:

NeighborImpact Home Preservation Loan Program Questionnaire