Program Inquiry and Request for Assistance

Open Enrollments for the Minor Rehabilitation and HOME Rehabilitation programs are available twice per year. Please note that submission of this form does not mean you will be assisted. If you need assistance with anything other than home repairs, please contact our office at (806) 775-2302 for more information. Para asistencia en español, por favor llame (806) 775-2301.



Contact Information

If you are seeking assistance for someone other than yourself, please complete the form with his or her information.

Do you own this home?
Do any household members meet at least one (1) of the following criteria? (Please check all that apply. If none, you may not qualify for assistance.)

Include income for anyone 18 and older and who are not in school. Types of income include: Retirement, Social Security, VA Benefits, Survivors Benefits, Gross Wages (Full/Part Time & Seasonal), Child Support, SNAP, TANF, Cash Contributions, etc.