Channel 2 Online Application

SECTION I - HOMEOWNER(S) INFORMATION

All fields marked with a red asterisk (*) are required.

Name of Homeowner(s) on title:
First and Last Name: *
Age: *
First and Last Name:
 Age:
Address: *
City: *
 Zip: *
Homeowner(s) Phone Number:
Homeowner(s) Email:
If no phone, please give Name and Phone Number of a friend/neighbor who could reach
Homeowner(s):
Name
 Phone
Is Homeowner(s) employed? * Yes   No
If yes, Name of Employer:
Salary:
Approximate year home was built: *
Approximate Market Value:
Number of years Homeowner(s) has resided at this address: *
Please check all that apply in describing this house: *
 
One Story
One-and-a-half Story
Two Story
Other: 		Brick Frame
Wood Frame
Siding Frame
Other: 		Flat Roof
Pitched Roof
Shingled Roof
Other: 		Basement
Garage
Trailer/Doublewide:
Year/Model
Please give Name, Age, Relationship to Homeowner(s), and Disabilities (if any) for each person living in household:
Name
 Age
 Relationship
 Disabilities
In case of emergency, the Christmas In April*Cecil County office should call:
Name *
Phone *
 Relationship to Homeowner(s) *
Number of Homeowner’s children living in or around Cecil County: *
Explain why repairs cannot be done by Homeowner(s) or family members: *
 
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Mailing Address: Christmas in April*Cecil County, P.O. Box 2303, Elkton, Maryland 21922-2303 | Telephone: 443-907-5289 Christmas in April*Cecil County is a 501(c)(3) organization. Gifts are tax deductible to the full extent allowable under the law.

 

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