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Paint the Town 2012 - Cheviot - Application
Paint the Town 2012 – Cheviot – Application
Paint the Town 2012 Application - Cheviot
ELIGIBILITY REQUIREMENTS:
- Own and live in their home
- Deadline to Apply - Feb. 15
- Be physically or financially unable to complete the work.
- Homes selected for painting must be located in Cheviot;
- The home must be in NEED of being painted to improve its appearance and value.
- If your home is selected, someone from your household must be present the day of the painting (June 9th);
After the selection of homes is completed, Give Back Cincinnati will notify home owners by May 1, 2011 of their selection for the event.
Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
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Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Alt Phone
*
Email
Age
*
Physical Disabilities (if any)
Total Annual Household Income (check one)
*
Under $20,000
$20,000 - $30,000
$30,000 - $40,000
$40,000 or more
How did you hear about Paint the Town?
*
TV
Radio
Neighbor
Community Council
Website
Community Event
Other
Home Information
Do You Own Your Home
*
Yes
No
Do You Live at the address on the application?
*
Yes
No
how many years have you lived in the home
*
Please enter a value between
0
and
100
.
How Many Children Live in the Home?
*
Size of Home
*
1 Story
2 Story
3 Story
Has the Exterior of the Home Been Painted
*
Yes
No
How Many Years Since the Exterior Was Painted?
*
Is the exterior of your home (check all that apply)
*
Wood Siding
Painted Brick
Stucco
Natural Brick (unpainted)
Aluminum Siding
Vinyl Siding
Other
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