Submit a Rock the Block Application

Application Status

Funding Program

Incomplete Reason

Denied Reason

Application Current Status

Application Dates

Received Date

Denied Date

Incomplete Date

Approved Date

In Scope Date

In Process Date

Completed Date

Application Address

Start Day

Site Number

Street

City

State

Zip

County

Applicant Information

First Name

Middle Initial

Last Name

Birthdate

Phone 1

Phone 2

Homeowner Email

Co-Applicant Information

Co-Applicant First Name

Co-Applicant Middle Initial

Co-Applicant Last Name

Co-Applicant DOB

Co-Applicant Phone 1

Co-Applicant Phone 2

Co-Applicant Email

Other Residents in Home

Please list any additional residents of the property other than the applicant and co-applicant.

Name of Other Resident 1

DOB of Other Resident 1

Name of Other Resident 2

DOB of Other Resident 2

Name of Other Resident 3

DOB of Other Resident 3

Name of Other Resident 4

DOB of Other Resident 4

Name of Other Resident 5

DOB of Other Resident 5

Name of Other Resident 6

DOB of Other Resident 6

Name of Other Resident 7

DOB of Other Resident 7

Name of Other Resident 8

DOB of Other Resident 8

Questions

Homeowner lives within the upcoming RTB area

Homeowner is willing to join the volunteers during RTB

Homeowner agrees to background screening

Homeowner is willing to pay the application fee

Homeowner certifies they meet the income guidelines

Homeowner would like assistance with

Unique email ending with @OrionHfhSoftware.com

Repair Activity

NRI Neighborhood

Month Completed

Head of Household Birthdate

Household Size

Number of Dependent Children in Home

Head of Household Disability Status

Is Head of Household a Veteran / Surviving Spouse

Is Head of Household a First Responder

Head of Household Gender

Homeowner Payment Date Deposited

Referred By

Submit a new Rock the Block Application