www.ChristmasInAprilCalvertCounty.org
P. O. Box 2761 Prince Frederick, MD 20678 410-535-9044

Homeowner Application DUE  September 30, 2018        DATE: _______________

NAME OF HOMEOWNER(S)
(All homeowners must live in their home)
HOME ADDRESS
MAILING ADDRESS
PHONE NUMBER

DIRECTIONS
HOUSE TYPE
AGE OF HOUSE                                

RESIDENT INFORMATION
NAME AGE RACE* RELATIONSHIP INCOME
DESCRIPTION OF
WORK REQUESTED
(List by priority)



Yes/No
Has this home been worked on in the past by Christmas in April?    
Is Homeowner aware of this referral?
Homeowner is (Check all that apply):
Elderly (over 60) Disabled Low income Veteran Other    If other please specify.
Please give name(s) of the legal homeowner(s):
Notes:
*In order to comply with reporting requirements, you are asked to identify your race. This information will not be used for, or have any effect on, selection decisions.

APPLICATION SUBMITTED BY:          DATE:
 
PHONE:        EMAIL ADDRESS:
 
ADDRESS:
 
 

If you have any questions about filling out the application or to report an issue plase contact us at apphelp@christmasinaprilcalvertcounty.org.

Christmas in April*Calvert County, Inc., in partnership with the community, repairs and improves houses assuring that low-income homeowners live in warmth, safety, and independence.
A United Way Partner
07/14
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