Test Form For Easthampton Council On Aging

Housing Rehabilitation Assistance, City of Easthampton

Please fill in this form to receive information on eligibility for assistance. All boxes are required.

By the way, right now this form just goes to Dave Chu, the designer/developer of this form, and a big fan of the Enrichment Center. If you’d like to use it, I can set it to go to any email address you’d like! You have to admit that this is easier than printing out a form, filling it in, getting a stamp, and mailing it or dropping it off (who uses printers anymore?), especially if it’s just for getting in touch with the people who could use the aid.

Housing Rehab Application
My Annual Income Is Not Greater Than (select one according to your household size):