HomePower Screening

Primary Applicant

First Name

Last Name

Phone

Area of Interest

Ethnicity

Race

Current Address

Physical Street Address

Physical City

Physical State

Physical Zip Code

Household Details

How many adults (18 yrs+) are in the household?

How many children are in the household?

Combined Annual Income for all Adults

Will you use the residence as your primary home and maintain it as your primary residence in the future

YesNo

You must certify that you will use the property as your primary residence.