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Landlord Repair Intake Form
Are you the legal owner of one of the following eligible property types? | 1) A residential property with 1 to 5 units (either currently or post-rehabilitation). 2) A mixed-use building that contains up to five (5) residential housing units. 3) A non-residential building or other structure that will be converted into one of the above eligible property types.
(Required)
Yes
No
Do you own a rental property located in Columbia, Dutchess, Greene, Orange, Putnam, Rockland, Sullivan, Ulster, or Westchester Counties?
(Required)
Yes
No
Is at least one unit in the property currently vacant and in need of rehabilitation to meet habitability standards?
(Required)
Yes
No
Are you willing to comply with the program's 10-year affordability requirements, including income and rent restrictions?
(Required)
Yes
No
The maximum award eligible is $75,000 per unit. Are you open to seeking other forms of financing if additional funds are needed to bring the unit online?
(Required)
Yes
No
This intake form is exclusively for property owners of eligible property types located in Columbia, Dutchess, Greene, Orange, Putnam, Rockland, Sullivan, Ulster, or Westchester Counties, with at least one vacant unit in need of rehabilitation, willing to comply with the 10 year affordability requirements, and open to seeking other forms of funding if additional funds are needed to bring the unit online. We appreciate your interest. If your circumstances change in the future, please feel free to revisit this form to see if you qualify.
1. Owner Contact Information
Name
(Required)
First
Last
Date of Birth:
(Required)
Phone
(Required)
Email
(Required)
What's your preferred language?
(Required)
English
Spanish
Other
Mailing Address:
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is your home and mailing address the same?
(Required)
Yes
No
Address:
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
How did you hear about us?
(Required)
Social Media
Search engine (
Email
Word of Mouth
Radio
Newspaper/Magazine
Other
What's your preferred method of communication?
(Required)
Phone
Email
Total Number of Properties Owned by or Under Control of Applicant
(Required)
Total Number of Residential Rental Units owned by or Under Control of Applicant
(Required)
2. Property Information
Home Address:
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County:
(Required)
Columbia
Dutchess
Greene
Orange
Putnam
Rockland
Sullivan
Ulster
Westchester
What year was the property built? (approx.)
(Required)
Number of units on the property
(Required)
Please enter a number from
1
to
8
.
Number of units currently empty
(Required)
Please enter a number from
1
to
8
.
Are you current on your property taxes?
(Required)
Yes
No
Is the property insured?
(Required)
Yes
No
List of home repairs needed? Include estimated cost.
(Required)
Upload estimates here (Optional)
Max. file size: 256 MB.
I understand that completing this intake form does not mean I have been placed on a waitlist. I understand that by completing this intake form, a RUPCO team member will review my information and determine if I might be eligible for current or future landlord repair funding.
(Required)
I understand that I will have to submit a program application when I am notified that funding is available.
(Required)
I understand that manufactured housing may not qualify for all repair programs
(Required)
I understand that grant programs require that I must be current in my mortgage and property taxes at the time I submit a program application
(Required)
I consent to receive paper and/or electronic communications from RUPCO and any of it's subsidiaries regarding this intake form.
(Required)
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