Submit RTB Application

Application Status

Funding Program

Application Current Status

Incomplete Reason

Denied Reason

Application Dates

Received Date

Denied Date

Incomplete Date

In Scope Date

In Process Date

Closed Pending Date

Completed Date

Section 1

Application Address

Site Number

Street

City

State

Zip

County

Applicant Information

First Name

Middle Initial

Last Name

Birthdate

Phone 1

Phone 2

Homeowner Email

Other Residents in Home

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

Other Residents in Home

Name of Other Resident 1

DOB of Other Resident 1

Relationship to Other Resident 1

Name of Other Resident 2

DOB of Other Resident 2

Relationship to Other Resident 2

Name of Other Resident 3

DOB of Other Resident 3

Relationship to Other Resident 3

Name of Other Resident 4

DOB of Other Resident 4

Relationship to Other Resident 4

Name of Other Resident 5

DOB of Other Resident 5

Relationship to Other Resident 5

Name of Other Resident 6

DOB of Other Resident 6

Relationship to Other Resident 6

Name of Other Resident 7

DOB of Other Resident 7

Relationship to Other Resident 7

Name of Other Resident 8

DOB of Other Resident 8

Relationship to Other Resident 8

Veteran Information

Veteran OR surviving spouse?

Name of Veteran

Primary Residence of Veteran

Branch of Service

Service Start Date

Service End Date

Years Served

Highest Rank

Hon. or General Discharge

Section 3

Residency

Applicant's primary residence?

Years in Home

Year Built

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