Form Center

2. 
   Residential Rehabilitation Application
   
   Please use the interactive online form below to apply for the Town of Brookhaven Residential Rehabilitation Program.

4. The Town of Brookhaven Residential Rehabilitation Program provides repairs to owner-occupied single-family homes in the Town, thereby stabilizing or increasing home values. Repairs can be made on any part of the home from the chimney to the sanitary system. Driveways, fences and landscaping are not included. Eligibility is determined by total household income and the income guidelines.

   Due to the large number of applicants, it is necessary to complete our application below to be added to our waiting list. Once your name is reached on the waiting list, you will receive an email requesting additional documents (PDF). Once those documents have been received and reviewed for eligibility, you will meet with a member of our staff to complete additional forms and to answer any questions you may have. Learn more about our Residential Rehabilitation Program.

   * indicates a required field

6. First Name*
7. Last Name*
8. Email Address*
10. Address (Must be a Brookhaven Town resident to be eligible)*
12. City*
13. State*
14. Zip Code*
16. Mailing Address (If Different)
18. Primary Phone*
    e.g. (555)555-5555
19. Cell Phone
    e.g. (555)555-5555
20. Home Phone
    e.g. (555)555-5555
21. Work Phone
    e.g. (555)555-5555
23. Annual Household Gross Income*
    Must meet annual household income guidelines (See table below)
24. Number of Persons in House*
25. Current with Mortgages & Taxes*

    1. Yes
    2. No (not eligible)
27. Annual Household Income Guidlines

    

29. Does Owner Reside In Home?*

    1. Yes
    2. No (not eligible)
30. If yes, is there a mortgage on the home?

    1. Yes
    2. No
31. Life Estate*

    1. Yes (not eligible)
    2. No
32. Reverse Mortgage*

    1. Yes (not eligible)
    2. No
34. Please be advised that you must have all valid documents pertaining to home ownership:*

    1. Handicap Accessibility Improvements
    2. Handicap Ramp or Lift

    1. Public Water Connections
    2. Residential Rehabilitation (brief description of work)

    Check all that apply.

36. Details*
38. Please confirm you meet our annual household income guidelines - View Now*

    1. Yes
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field