Paint the Town 2012 — Cheviot — Application

Paint the Town 2012 Application - Cheviot

ELIGIBILITY REQUIREMENTS:

Own and live in their home
Deadline to Apply - Feb. 15
Be physically or financially unable to complete the work.
Homes selected for painting must be located in Cheviot.
The home must be in NEED of being painted to improve its appearance and value.
If your home is selected, someone from your household must be present the day of the painting (June 9th)

After the selection of homes is completed, Give Back Cincinnati will notify home owners by May 1, 2011 of their selection for the event.

Name *

First

Last

Address *

Street Number

Street Name

City

State

Zip Code

Phone *

Alt Phone *

Age * Physical Disabilities?

Physical Disabilities Details

Total Annual Household Income (check one) *

Under $20,000
$20,000 - $30,000
$30,000 - $40,000
$40,000 or more

How did you hear about Paint the Town? *

Do You Own Your Home? *

Yes
No

Do You Live at the address on the application? *

Yes
No

How many years have you lived in the home * How Many Children Live in the Home? *

Size of Home *

1 Story
2 Story
3 Story

Has the Exterior of the Home Been Painted *

Yes
No

Is the exterior of your home (check all that apply) *