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Posted on: August 31, 2020

Public Information CDBG Grant Application

2020 Urgent Repair Program

Request for Assistance

Moore County Planning & Transportation Department

 

Pre-Application due to Planning & Transportation Department by 4:30pm on Wednesday, Sept. 30, 2020

 

Homeowner Name:  ___________________________________________________________________


Physical Address of Home: ______________________________________________________________


Mailing Address: ______________________________________________________________________


Point of Contact (If different than homeowner): _______________________________________________


Telephone Number(s): __________________________________________________________________


Monthly Income (Social Security, SSI, Pension, Wages from Job, etc.) =_____________________

 

First and last names of persons living in home

(including homeowner)

 

 

 

Date of Birth

Disability - including physical or mental but not related to substance abuse (Yes/No)

 

 

 

Military Veteran

(Yes/No)

Child with elevated blood lead levels living in the home? (Yes/No)

 

 

 

Race

 

Received prior housing rehab assistance from Moore County? (Yes/No)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mail completed form to:                Carlis P. Sweat

                                                      Moore County Planning & Transportation Department         

                                                      PO Box 905

                                                      Carthage, NC 28327

 

Information provided above will be used to rate and rank applicants based on the Priority system outlined within the programs Assistance Policy.  Failure to complete all areas may cause the inability to be ranked.

All program information is kept confidential.  Please call Moore County Planning & Transportation Department with questions at 910-947-5010.


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